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Underlying Cause Modulates Excess Mortality Risk Associated With Hypopituitarism

From: http://diabetes.medscape.com/reuters/prof/2001/02/02.09/20010208epid004.html

WESTPORT, CT (Reuters Health) Feb 08 - Age at diagnosis, female sex, and craniopharyngioma but not endocrine-axis deficiencies appear to be independent risk factors for mortality from vascular and respiratory disease associated with hypopituitarism, according to the results of a population-based study in the UK.

While excess mortality among patients with hypopituitarism has been previously reported, there is no consensus as to the cause, Dr. Paul M. Stewart from the University of Birmingham and colleagues note in The Lancet for February 10. To investigate, the researchers followed up 1014 patients with hypopituitarism from January 1992 to January 2000.

Of these patients, 514 were men and 500 were women. Fifty-seven percent of the patients had non-functioning adenomas, 12% craniopharyngiomas and 9% prolactinomas, according to the report.

Dr. Stewart's team reports that there were 181 deaths among these patients compared with 97.7 expected deaths, yielding a standardized mortality ratio of 1.87. Excess mortality was attributable to cardiovascular, respiratory and cerebrovascular causes.

Univariate analysis showed that mortality was greater among women than among men, in younger patients, and in patients with diagnosed craniopharyngioma. Mortality was also higher in the 353 patients who underwent radiotherapy.

"There was no effect of hormonal deficiency on mortality, except for gonadotropin deficiency, which if untreated was associated with excess mortality," Dr. Stewart's team writes.

"The very poor outcome in patients with craniopharyngiomas reminds us that hypopituitarism is not a single disease. Each patient requires an individual assessment not only of their hormonal deficiency and extent of disease, but also of their underlying diagnosis, before deciding upon management strategies," Dr. Stewart and colleagues conclude.

Lancet 2001;357:425-431.



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