Endocrine Abstracts

Background and aims: Patients with GH secreting or nonfunctioning pituitary adenoma (NFPA) have high mortality ratios, despite enhancement of the old therapies. The aim of the study is to analyze the relationship between mortality and risk factors, including therapy, in patients with acromegaly (ACM) and NFPA evaluated in the last 16 years.

Methods: We evaluated retrospectively 749 patients with pituitary adenoma (435F/314M), 386 with ACM and 363 with NFPA, between 2001–2007 and 2008–2016. Standard mortality ratio (SMR) was calculated as the ratio between observed and expected number of deaths. A multivariable Cox regression was used to calculate hazard ratios (HR) for all-cause mortality risk factors.

Results: In patients with ACM- follow-up 3286.88 person-years (median 8.5 years), mortality ratio was increased (observed deaths: n=62) against expected (n=38): SMR=1.60 (95% Confidence Interval (CI) 1.23–2.06), while in NFPA- follow-up 2570.70 person-years (median 7.5 years), SMR was 1.38 (95% CI 1.05–1.79). Females with both ACM and NFPA had doubled mortality ratio: SMR=2.19 (95% CI 1.57–2.98) and 2.00 (95% CI 1.28–2.97), respectively. At multivariate regression analysis, age, post-treatment GH and tumor diameter were independently correlated to mortality in ACM (HR 1.085 (95%CI 1.058–1.114, P<0.001; HR 1.018 (95%CI 1.006–1.031, P=0.003), and respectively HR 1.041 (95%CI 1.004–1.080, P=0.03), while age and remnant tumor diameter were correlated to mortality in NFPA patients (HR 1.07 (95%CI 1.044–1.099, P<0.001 and respectively HR 1.02(95%CI 1.008–1.051, P=0.018)). Patients diagnosed before 2008 died more frequently than patients diagnosed since 2008 (109/415 vs 14/334, respectively), but with longer follow-up (10.99±3.94 vs 4.34±2.45 years, respectively). Regarding pituitary tumor treatment, proportion of patients with ACM receiving neurosurgery (58.5% before 2008 vs 73.68% since 2008, P=0.002), radiotherapy (61.96% before 2008 vs 20.39% after 2008, P<0.001) and medical treatment (52.13% vs 65.13%, P=0.008) changed, but the ratio of cured and medically controlled ACM did not changed (54.93%vs 56.57%, respectively, P=0.06). Pituitary insufficiency was more frequent in patients diagnosed before 2008 on all axes (gonadic/thyroid/adrenal: 37.17/26.49/16.66%) vs patients diagnosed after 2008 (21.19/11.92/5.9%, respectively), reflecting the greater proportion of irradiated patients and longer follow-up. Average post treatment GH, IGF1 levels and pituitary tumor remnant diameter were not different before or after 2008.

Conclusion: Patients with GH secreting or nonfunctioning pituitary adenoma had still high mortality ratios, especially in females. Efficacy of changes in therapy after 2008 need longer follow up to see changes in mortality.