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Life expectancy in patients with pituitary adenoma receiving growth hormone replacement.

Journal article
Authors Daniel S Olsson
Penelope Trimpou
Tobias Hallén
Ing-Liss Bryngelsson
Eva Andersson
Thomas Skoglund
Bengt-Åke Bengtsson
Gudmundur Johannsson
Anna G Nilsson
Published in European journal of endocrinology
Volume 176
Issue 1
Pages 67-75
ISSN 1479-683X
Publication year 2017
Published at Institute of Medicine, Department of Internal Medicine and Clinical Nutrition
Pages 67-75
Language en
Links dx.doi.org/10.1530/EJE-16-0450
www.ncbi.nlm.nih.gov/entrez/query.f...
Subject categories Endocrinology

Abstract

Hypopituitarism has been associated with increased mortality. The excess mortality may be due to untreated growth hormone (GH) deficiency but also due to various underlying disorders. We therefore analysed mortality in patients with only one underlying disorder, non-functioning pituitary adenoma (NFPA), with and without GH replacement therapy (GHRT).Patients with NFPA in the western region of Sweden, 1997-2011, were identified through the National Patient Registry and cross-referenced with several National Health Registries. All patient records were reviewed. Standardised mortality ratios (SMRs) with 95% confidence intervals (CIs) were calculated using the general population as reference. Cox-regression models were performed to identify predictors of mortality.A total of 426 NFPA patients with 4599 patient-years were included, of whom 207 had used GHRT and 219 had not received GHRT. Median (range) follow-up in patients with and without GHRT was 12.2 (0-25) and 8.2 (0-27) years, respectively. Other pituitary hormone deficiencies were more frequent in the GHRT group than those in the non-GHRT group. SMR was 0.65 (95% CI, 0.44-0.94; P = 0.018) for the GHRT group and 1.16 (0.94-1.42; P = 0.17) for the non-GHRT group. Direct comparison between the groups showed reduced mortality among those who were GH replaced (P = 0.0063). The SMR for malignant tumours was reduced in the GHRT-group (0.29; 0.08-0.73; P = 0.004) but not in untreated patients.Selection bias explaining some of the results cannot be excluded. However, NFPA patients with GHRT had reduced overall mortality compared with the general population, and death due to malignancy was not increased. This suggests that long-term GHRT is safe in adult patients selected for treatment.

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