Endocrine Abstracts

Introduction: Data on the mortality of patients with non-functioning pituitary macroadenoma (NFA) are limited. Aim: To assess the mortality of patients with NFA and predictive factors.

Patients/methods: All patients presenting to our Department with NFA between 1963 and 2011 were studied. Status was recorded as either dead or alive, as of 31 December 2011.

Results: 546 patients (333 males) were identified (median age at surgery 58.7 years; range 16.1–94.2). Data on mortality were available for all patients covering a median period of 8 years (range 1 month-48.5 years); 83 patients died (median age 77.8 years; range 36.4–98.3) (causes: cardio/cerebrovascular 33.7%, infections 30.1%, malignancies 28.9%, peri-operatively 1.2%, gastrointestinal haemorrhage 1.2%, suicide 1.2%, unknown 2.4%, old age 1.2%). SMR for total group:3.62 (95% CI:2.90–4.47; P<0.001), for those diagnosed before 1990:4.66 (95% CI:2.65–7.63; P<0.001) and for those after 1990:3.53 (95% CI:2.77–4.44; P<0.001). Clinical follow-up data (until date of death or date the database was frozen) were available for 436 patients [269 males, median age at surgery 58.5 years; range 16.11–94.19), 203/431 with no or intrasellar remnant – 228/431 with extrasellar remnant after surgery, median follow-up 6.9 years (range 1 month-48.5 years), 111/436 with NFA regrowth, 188/436 received radiotherapy adjuvant or for regrowth]. Cox regression analysis (univariate followed by multivariate approach) demonstrated that amongst age at surgery, NFA regrowth, radiotherapy, sex, extent of removal, untreated GH deficiency, untreated FSH/LH deficiency, ACTH deficiency, TSH deficiency and treatment with DDAVP, only age remained an independent significant factor (HR 1.099, 95% CI: 1.073–1.126; P<0.001).

Conclusions: This is the first study assessing mortality in a large series of non-selected patients with NFA in the UK. Despite the improvement in the last three decades, mortality remains high. Apart from age, factors related with the management/outcome of the tumour are not independent predictors and pituitary hormone deficits managed with the currently used substitution protocols do not adversely affect mortality in this group of patients.