title: Excess Mortality in Women and Young Adults With Nonfunctioning Pituitary Adenoma: A Swedish Nationwide Study.
abstract: BACKGROUND
  Patients with hypopituitarism of various etiologies have excess mortality. The mortality in patients with nonfunctioning pituitary adenoma (NFPA), regardless of pituitary function, is less well studied.
  
  
  OBJECTIVE
  Our aim was to investigate mortality in patients with NFPA and to examine whether age at diagnosis, gender, tumor treatments, or hormonal deficiencies influence the outcome.
  
  
  METHODS
  NFPA patients were identified and followed up in nationwide health registries in Sweden, 1987-2011. The criteria for identification were tested and validated in a subpopulation of the patients.
  
  
  METHODS
  This was a nationwide, population-based study.
  
  
  METHODS
  A total of 2795 unique patients with NFPA (1502 men, 1293 women) were identified and included in the study. Mean age at diagnosis was 58 years (men, 60 y; women, 56 y) and mean follow-up time was 7 years (range 0-25 y).
  
  
  METHODS
  There were no interventions.
  
  
  METHODS
  Standardized mortality ratios (SMRs) and annual incidence rates were calculated using the Swedish population as reference and presented with 95% confidence intervals.
  
  
  RESULTS
  Annual incidence of NFPA was 20.3 (18.8-21.9) cases per 1 million inhabitants. During the observation period, 473 patients died against an expected 431, resulting in an SMR of 1.10 (1.00-1.20). Patients diagnosed at younger than 40 years of age had an increased SMR of 2.68 (1.23-5.09). The SMR for patients with hypopituitarism (n = 1500) was 1.06 (0.94-1.19), and for patients with diabetes insipidus (n = 145), it was 1.71 (1.07-2.58). The SMR was increased in women with NFPA (1.29; 1.11-1.48) but not in men (1.00; 0.88-1.12). Women, but not men, with a diagnosis of hypopituitarism and/or diabetes insipidus also had an increased mortality ratio. SMRs due to cerebrovascular (1.73; 1.34-2.19) and infectious diseases (2.08; 1.17-3.44) were increased, whereas the SMR for malignant tumors was decreased (0.76; 0.61-0.94).
  
  
  CONCLUSIONS
  This nationwide study of patients with NFPA showed an overall excess mortality in women and in patients with a young age at diagnosis. Increased mortality was seen for cerebrovascular and infectious diseases.
authors.affiliation: Department of Endocrinology (D.S.O., A.G.N., P.T., G.J.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden; Department of Occupational and Environmental Medicine (I.-L.B.), Örebro University Hospital, SE-701 85 Örebro, Sweden; and Department of Occupational and Environmental Medicine (E.A.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, SE-405 30 Gothenburg, Sweden.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Olsson
authors.affiliation: Department of Endocrinology (D.S.O., A.G.N., P.T., G.J.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden; Department of Occupational and Environmental Medicine (I.-L.B.), Örebro University Hospital, SE-701 85 Örebro, Sweden; and Department of Occupational and Environmental Medicine (E.A.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, SE-405 30 Gothenburg, Sweden.
authors.forename: Anna G
authors.initials: AG
authors.lastname: Nilsson
authors.affiliation: Department of Endocrinology (D.S.O., A.G.N., P.T., G.J.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden; Department of Occupational and Environmental Medicine (I.-L.B.), Örebro University Hospital, SE-701 85 Örebro, Sweden; and Department of Occupational and Environmental Medicine (E.A.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, SE-405 30 Gothenburg, Sweden.
authors.forename: Ing-Liss
authors.initials: IL
authors.lastname: Bryngelsson
authors.affiliation: Department of Endocrinology (D.S.O., A.G.N., P.T., G.J.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden; Department of Occupational and Environmental Medicine (I.-L.B.), Örebro University Hospital, SE-701 85 Örebro, Sweden; and Department of Occupational and Environmental Medicine (E.A.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, SE-405 30 Gothenburg, Sweden.
authors.forename: Penelope
authors.initials: P
authors.lastname: Trimpou
authors.affiliation: Department of Endocrinology (D.S.O., A.G.N., P.T., G.J.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden; Department of Occupational and Environmental Medicine (I.-L.B.), Örebro University Hospital, SE-701 85 Örebro, Sweden; and Department of Occupational and Environmental Medicine (E.A.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, SE-405 30 Gothenburg, Sweden.
authors.forename: Gudmundur
authors.initials: G
authors.lastname: Johannsson
authors.affiliation: Department of Endocrinology (D.S.O., A.G.N., P.T., G.J.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden; Department of Occupational and Environmental Medicine (I.-L.B.), Örebro University Hospital, SE-701 85 Örebro, Sweden; and Department of Occupational and Environmental Medicine (E.A.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, SE-405 30 Gothenburg, Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Andersson
mesh_terms: D000236:Adenoma / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000401:mortality*; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult