ECE2022 Poster Presentations Pituitary and Neuroendocrinology (127 abstracts)
Pre and post-surgical pituitary dysfunction increase the risk of mortality in patients with non-functioning pituitary tumors: A long-term cohort study
Arturo Beyhart 1,2 , Karla Mariaca 2 , Valeria Salva-Crespi 1 , Daniela Díaz Catalán 1 , Iban Aldecoa 3 , Maria L Olondo 4 , Bernardo Sanchez-Dalmau 5 , Isam Alobid 6 , Irene Halperin 2 , Mireia Mora 1,2 , Joaquim Enseñat 7 & Felicia Alexandra Hanzu 1,2
1IDIBAPS, Group of Endocrine Disorders, Barcelona, Spain; 2Hospital Clinic, Endocrinology and Metabolism, Barcelona, Spain; 3Hospital Clinic, Pathological Anatomy Centre, Barcelona, Spain; 4Hospital Clinic, Image Diagnostic Centre, Barcelona, Spain; 5Hospital Clinic, Ophthalmology Department, Barcelona, Spain; 6Hospital Clinic, Otorhinolaryngology, Barcelona, Spain; 7Hospital Clinic, Surgery Department, Barcelona, Spain
Background: Long-term studies evaluating mortality in patients with non-functioning (NF) pituitary tumors (PitNets) are limited, although standardized mortality ratios (SMR) in these patients are reported to be higher than that of general population. There is also no agreement on predictive factors associated to the increased mortality apart from age at diagnosis and glucocorticoid substitution therapy dose.
Objective: To assess long-term mortality and associated predictive factors in a single-surgeon cohort of patients with NF PitNets.
Methods: Patients <80 years at diagnosis with a NF PitNet surgically intervened between 2005 and 2015 in the Hospital Clínic Barcelona Spain (n=90, 51 females) were followed until censored date (01 December 2021) exitus or loss of follow up. Standardized mortality ratios (SMRs) were calculated using Catalan death rates from included years. Proportional hazards of mortality predictors were assessed by cox regression models. All-cause mortality survival rates were assessed by Kaplan-Meier curves. All analyses were adjusted by age and sex.
Results: Median follow-up was 7 years (range: 1 month–13 years) with a total patient-years of 808. Fifteen patients (16.6%) (5 females) died during the study period at a mean age of 74 ± 11 years. At half of study follow up (93 months), survival rate was 93% for females and 76% for males (P=0.083). Main causes of death were associated to infections, malignancy, and cardiovascular diseases. Gender, age at diagnosis, corticotroph deficiency at diagnosis, tumor extension to the sphenoid sinus, tumor contact with the optical chiasm and tirotroph affection due to surgery were associated to exitus in univariate analysis (P<0.03). However, only corticotroph deficiency at diagnosis and tirotroph affection due to surgery remained independently associated in multivariate cox regression analysis with a hazard ratio of 2.96 (95% CI, 1.32-7.91) and 3.99 (95% CI, 1.87-18.23) respectively. Kaplan-Meir log rank factor comparison showed that corticotroph deficiency at diagnosis was also associated with a younger death age (73.3 vs 81.9 years, P=0.021). Overall SMR adjusted by age and sex was 3.92 in the whole cohort with respect to Catalan population (P<0.001) and higher SMR for patients with tirotroph affection due to surgery was found (9.02 (P<0.001)).
Conclsion: Although NF PitNets have a benign behavior, patients maintain substantially higher mortality rates than general population. Affections of pituitary hormonal axes either due to the mass effect of the tumor or because of neurosurgery are key risk factors associated to increased and earlier mortality.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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