title: Doubled mortality rate in irradiated patients reoperated for regrowth of a macroadenoma of the pituitary gland.
abstract: BACKGROUND
  Reduced life expectancy has been shown in patients with hypopituitarism, mainly caused by cardiovascular diseases. A major cause of hypopituitarism is pituitary adenomas, and radiotherapy may be employed as a treatment modality to reduce the post-operative regrowth rate of these tumours. Recently, we showed that in patients with craniopharyngiomas, tumour regrowth foreshadowed a fourfold risk increase for death. For patients with pituitary adenomas, the impact of regrowth on life expectancy is, however, not known.
  
  
  OBJECTIVE
  To assess the impact of a reoperation due to a regrowth of a pituitary macroadenoma on mortality, taking into account other candidate prognostic factors.
  
  
  METHODS
  In 281 patients with operated and irradiated macroadenomas, excluding acromegaly and Cushing's disease, 35 patients had a regrowth (median follow-up 16.6 years). Possible risk factors for tumour regrowth were investigated by Cox regression models.
  
  
  RESULTS
  For tumour regrowth, age, calendar time at primary surgery, gender and extension of tumour growth had no statistically significant impact. For younger patients, the proportion of regrowths was higher, but after age-stratified Cox regression analysis only regrowth was shown to have a significant impact on mortality, with a more than doubled mortality risk for patients with tumour regrowth as compared with the non-regrowing tumour patients (hazard ratio=2.24, P<0.001). This finding was corroborated by cohort analyses using the general population as an external comparison group.
  
  
  CONCLUSIONS
  Among patients with irradiated pituitary macroadenomas, excluding acromegaly and Cushing's disease, a doubled mortality rate was observed for those reoperated for tumour regrowth as compared with patients with non-regrowing tumours.
authors.affiliation: Department of Internal Medicine, Division of Diabetology and Endocrinology, Lund University Hospital, S-221 85 Lund, Sweden. Eva_Marie_erfurth@med.lu.se
authors.forename: Eva Marie
authors.initials: EM
authors.lastname: Erfurth
authors.forename: Birgitta
authors.initials: B
authors.lastname: Bulow
authors.forename: Carl-Henrik
authors.initials: CH
authors.lastname: Nordström
authors.forename: Zoli
authors.initials: Z
authors.lastname: Mikoczy
authors.forename: Lars
authors.initials: L
authors.lastname: Hagmar
authors.forename: Ulf
authors.initials: U
authors.lastname: Strömberg
mesh_terms: D000236:Adenoma / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery; D010911:Pituitary Neoplasms / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery*; D011379:Prognosis; D016016:Proportional Hazards Models; D012086:Reoperation / Q000401:mortality; D012307:Risk Factors