SFEBES2015 Poster Presentations Pituitary (48 abstracts)
ACTH and gonadotrophin deficiency predict mortality in patients treated for non-functioning pituitary adenomas (NFPAs) in the UK and Republic of Ireland: long-term follow-up of 519 patients across two tertiary referral centres
Michael O’Reilly 1 , Raoul Reulen 2 , Saket Gupta 3 , Rosemary Dineen 3 , C Thompson 3 , Harriet Pearce 1 , Gabriella Bugg 1 , Andrew Toogood 1 , Neil Gittoes 1 , Christopher Thompson 3 & John Ayuk 1
1Department of Endocrinology, University Hospitals Birmingham, Birmingham, UK; 2School of Health and Population Sciences, University of Birmingham, Birmingham, UK; 3Division of Endocrinology, Beaumont Hospital and RCSI Medical School, Dublin, Ireland.
Non-functioning pituitary adenomas (NFPAs) are the commonest subtype of pituitary tumour. Surgical resection, accompanied by radiotherapy (RTX) in selected cases, is the treatment of choice for compressive tumours. Long-term health consequences of treatment for NFPAs are unclear. In this retrospective study, we assessed long-term pituitary function and mortality rates in a large NFPA cohort across two tertiary centres in the UK and Ireland.
Case-note review of all patients treated for NFPA in University Hospitals Birmingham and Beaumont Hospital Dublin between 1997 and 2012 was performed. Clinical presentation, treatment strategy and pituitary function at last clinic visit were recorded in each case. Data on mortality was recorded via Clinical Portal in Birmingham and via GP contact in Dublin. Mortality risk was calculated by external Poisson regression for comparison with the general population.
A total of 519 patients were included in the analysis (Birmingham n=271, Dublin n=248). Mean duration of follow-up was 8.4±6.3 years. The rate of pituitary irradiation was higher in Birmingham than in Dublin (42.4 vs 27.5%, p<0.001). The rate of panhypopituitarism was significantly higher in RTX-treated compared to RTX-naïve patients (51.1 vs 39.8%, p<0.001). A total of 78 deaths were recorded (15.02%). On external Poisson regression incorporating mortality rates in the background UK and Irish populations, ACTH and gonadotrophin deficiency were associated with increased relative risk of death (OR 2.24, 95% CI 1.14–4.40, P=0.01, and OR 2.47, 95% CI, 1.07–5.70, P=0.02, respectively) after adjustment for RTX, age at diagnosis and attained age. RTX was not independently associated with an increased relative risk of death.
Hypopituitarism may be associated with increased mortality rates in patients treated for NFPA. Specifically, ACTH- and gonadotrophin-deficient patients have increased mortality rates compared to the background population. Further studies are necessary to determine if these associations are directly related to hypopituitarism or to its treatment.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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