Endocrine Abstracts

Following seminal observations published nearly 20 years ago, it is apparent, increasingly, that patients with pituitary disease have excess mortality due to cardiovascular, cerebrovascular and respiratory causes; with women having a worse outcome than men. Patients with craniopharygioma have the greatest risk. There does not appear to be an overall excess of death due to malignancy. Despite large retrospective and prospective database cohort analyses, the precise reasons for these observations remain to be determined. Numerous factors have the potential to account for the observed excess mortality.

Pituitary hormone deficiency makes intuitive sense as a candidate to explain excess cardiovascular death, but controversy exists as to whether deficiencies in the major axes, and their replacement or lack of it, influences the observed mortality. Although replacement therapy on an individualised basis improves quality of life, UK cohort data suggest overall that glucocorticoid, thyroxine and growth hormone deficiency do not account for excess mortality, whilst sex steroid replacement reduces risk, but not to normal. More recent data, however, show excess cardiovascular risk factors associated with higher doses of glucocorticoid. An important issue is that the cohort studies have not included systematic testing of all pituitary hormones in every patient, and the lack of universal agreement of the precise cut-offs defining deficiency.

Major debate exists as to whether radiotherapy per se or hormone deficiency is associated with excess cerebrovascular disease, or whether this is explained by this technique being used in younger patients and in those with more severe disease.

Finally, the reasons for excess respiratory death, remains to be determined.