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Study Offers Clues to Pituitary Disease Deaths

NEW YORK (Reuters Health) - While doctors have known that patients with underactive pituitary glands are at risk of premature death, the reasons have remained unclear. Now new research is shedding light on the underlying causes.

The condition is known as hypopituitarism, and it usually arises in patients with tumors of the pituitary gland in the brain. The pituitary gland is considered the body's thermostat, monitoring the function of various other glands and organs. Pituitary tumors themselves are typically benign, but when hypopituitarism develops it causes a deficiency in hormones involved in such vital functions as growth and development, reproduction and sexual function, and metabolism.

In a study of more than 1,000 patients with hypopituitarism, UK researchers found that death risk was increased among women, younger patients, and those with a brain tumor that arises near the pituitary known as a craniopharyngioma. Patients who received no treatment for deficiency in the reproductive hormone gonadotropin also had a higher death risk.

Dr. Jeremy W. Tomlinson of the University of Birmingham led the study. The findings are published in the February 10th issue of The Lancet.

Over 8 years, 181 study patients died, nearly twice the number of deaths that would be expected in the general population. When Tomlinson's team dug for the factors that separated those who died from survivors, they found that women were more likely than men to have died. In addition, death risk was greatest among patients diagnosed with hypopituitarism before age 40, and the 12% who had underlying craniopharyngioma.

Most patients died of respiratory illness or heart disease, which have already been linked to hypopituitarism. Patients with craniopharyngioma had nearly 10 times the risk of dying as those with other causes of pituitary impairment. This, according to the researchers, may reflect the metabolic abnormalities linked to this type of tumor--namely obesity.

This study "reminds us that hypopituitarism is not a single disease," Tomlinson and colleagues note. Each patient must have the disease managed based on the underlying cause, the authors conclude.

SOURCE: The Lancet 2001;357:425-431.

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