title: The incidence of cerebrovascular accidents and second brain tumors in patients with pituitary adenoma: a population-based study.
abstract: BACKGROUND
  To assess the risk of cerebrovascular accidents (CVAs) and second brain tumors (SBTs) in patients with pituitary adenoma after surgery or radiotherapy.
  
  
  METHODS
  A cohort of 143 people from Olmsted County, who were diagnosed with pituitary adenoma between 1933 and 2000, was studied. Only patients from Olmsted County were included because of the unique nature of medical care in Olmsted County, which allows the ascertainment of virtually all cases of pituitary adenoma for this community's residents and comparisons to the general population in the county. Surgical resection was performed in 76 patients, 29 patients underwent radiotherapy (with 21 undergoing both surgery and radiotherapy), 5 patients were reirradiated, and 59 patients were managed conservatively and observed.
  
  
  RESULTS
  Median follow-up was 15.5 years. There was no difference in CVA-free survival between treatment groups. On univariate analysis age > 60 years (hazard ratio [HR], 11.93; 95% CI, 6.26-23.03;P< .001); male sex (HR, 3.67; 95% CI, 2.03-6.84;P< .001), and reirradiation (HR, 3.41; 95% CI, 1.05-9.68;P= .04) were associated with worse CVA-free survival. In multivariate analysis, only age > 60 years was associated with worse CVA-free survival. Compared with the general population, there was a 4-fold increase in the rate of CVAs in pituitary adenoma patients (HR, 4.2; 95% CI, 2.8-6.1). Two patients developed SBT (an irradiated patient and a surgically managed patient).
  
  
  CONCLUSIONS
  CVA is a significant risk for patients with pituitary tumors, but treatment does not seem to impact the risk. Even with long-term follow-up, SBTs are a rare event regardless of treatment modality.
authors.affiliation: Department of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston, Texas (P.D.B.); Department of Radiation Oncology , Mayo Clinic , Rochester, New York (P.D.B., M.B., C.A.B., R.W.K., B.E.P., Y.I.G., S.L.S., R.L.F., N.N.I.L.); School of Medicine and Health Sciences, University of North Dakota , Grand Forks, North Dakota (K.J.); Department of Neurology , Mayo Clinic , Rochester, New York (K.D.F.); Department of Health Sciences Research , Mayo Clinic , Rochester, New York (D.J.J., J.S.); Department of Neurosurgery , Mayo Clinic , Rochester, New York (B.E.P., M.J.L.); Department of Endocrinology, Metabolism and Nutrition , Mayo Clinic , Rochester, New York (D.E.).
authors.forename: Paul D
authors.initials: PD
authors.lastname: Brown
authors.affiliation: Department of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston, Texas (P.D.B.); Department of Radiation Oncology , Mayo Clinic , Rochester, New York (P.D.B., M.B., C.A.B., R.W.K., B.E.P., Y.I.G., S.L.S., R.L.F., N.N.I.L.); School of Medicine and Health Sciences, University of North Dakota , Grand Forks, North Dakota (K.J.); Department of Neurology , Mayo Clinic , Rochester, New York (K.D.F.); Department of Health Sciences Research , Mayo Clinic , Rochester, New York (D.J.J., J.S.); Department of Neurosurgery , Mayo Clinic , Rochester, New York (B.E.P., M.J.L.); Department of Endocrinology, Metabolism and Nutrition , Mayo Clinic , Rochester, New York (D.E.).
authors.forename: Miran
authors.initials: M
authors.lastname: Blanchard
authors.affiliation: Department of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston, Texas (P.D.B.); Department of Radiation Oncology , Mayo Clinic , Rochester, New York (P.D.B., M.B., C.A.B., R.W.K., B.E.P., Y.I.G., S.L.S., R.L.F., N.N.I.L.); School of Medicine and Health Sciences, University of North Dakota , Grand Forks, North Dakota (K.J.); Department of Neurology , Mayo Clinic , Rochester, New York (K.D.F.); Department of Health Sciences Research , Mayo Clinic , Rochester, New York (D.J.J., J.S.); Department of Neurosurgery , Mayo Clinic , Rochester, New York (B.E.P., M.J.L.); Department of Endocrinology, Metabolism and Nutrition , Mayo Clinic , Rochester, New York (D.E.).
authors.forename: Krishan
authors.initials: K
authors.lastname: Jethwa
authors.affiliation: Department of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston, Texas (P.D.B.); Department of Radiation Oncology , Mayo Clinic , Rochester, New York (P.D.B., M.B., C.A.B., R.W.K., B.E.P., Y.I.G., S.L.S., R.L.F., N.N.I.L.); School of Medicine and Health Sciences, University of North Dakota , Grand Forks, North Dakota (K.J.); Department of Neurology , Mayo Clinic , Rochester, New York (K.D.F.); Department of Health Sciences Research , Mayo Clinic , Rochester, New York (D.J.J., J.S.); Department of Neurosurgery , Mayo Clinic , Rochester, New York (B.E.P., M.J.L.); Department of Endocrinology, Metabolism and Nutrition , Mayo Clinic , Rochester, New York (D.E.).
authors.forename: Kelly D
authors.initials: KD
authors.lastname: Flemming
authors.affiliation: Department of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston, Texas (P.D.B.); Department of Radiation Oncology , Mayo Clinic , Rochester, New York (P.D.B., M.B., C.A.B., R.W.K., B.E.P., Y.I.G., S.L.S., R.L.F., N.N.I.L.); School of Medicine and Health Sciences, University of North Dakota , Grand Forks, North Dakota (K.J.); Department of Neurology , Mayo Clinic , Rochester, New York (K.D.F.); Department of Health Sciences Research , Mayo Clinic , Rochester, New York (D.J.J., J.S.); Department of Neurosurgery , Mayo Clinic , Rochester, New York (B.E.P., M.J.L.); Department of Endocrinology, Metabolism and Nutrition , Mayo Clinic , Rochester, New York (D.E.).
authors.forename: Cerise A
authors.initials: CA
authors.lastname: Brown
authors.affiliation: Department of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston, Texas (P.D.B.); Department of Radiation Oncology , Mayo Clinic , Rochester, New York (P.D.B., M.B., C.A.B., R.W.K., B.E.P., Y.I.G., S.L.S., R.L.F., N.N.I.L.); School of Medicine and Health Sciences, University of North Dakota , Grand Forks, North Dakota (K.J.); Department of Neurology , Mayo Clinic , Rochester, New York (K.D.F.); Department of Health Sciences Research , Mayo Clinic , Rochester, New York (D.J.J., J.S.); Department of Neurosurgery , Mayo Clinic , Rochester, New York (B.E.P., M.J.L.); Department of Endocrinology, Metabolism and Nutrition , Mayo Clinic , Rochester, New York (D.E.).
authors.forename: Robert W
authors.initials: RW
authors.lastname: Kline
authors.affiliation: Department of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston, Texas (P.D.B.); Department of Radiation Oncology , Mayo Clinic , Rochester, New York (P.D.B., M.B., C.A.B., R.W.K., B.E.P., Y.I.G., S.L.S., R.L.F., N.N.I.L.); School of Medicine and Health Sciences, University of North Dakota , Grand Forks, North Dakota (K.J.); Department of Neurology , Mayo Clinic , Rochester, New York (K.D.F.); Department of Health Sciences Research , Mayo Clinic , Rochester, New York (D.J.J., J.S.); Department of Neurosurgery , Mayo Clinic , Rochester, New York (B.E.P., M.J.L.); Department of Endocrinology, Metabolism and Nutrition , Mayo Clinic , Rochester, New York (D.E.).
authors.forename: Debra J
authors.initials: DJ
authors.lastname: Jacobson
authors.affiliation: Department of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston, Texas (P.D.B.); Department of Radiation Oncology , Mayo Clinic , Rochester, New York (P.D.B., M.B., C.A.B., R.W.K., B.E.P., Y.I.G., S.L.S., R.L.F., N.N.I.L.); School of Medicine and Health Sciences, University of North Dakota , Grand Forks, North Dakota (K.J.); Department of Neurology , Mayo Clinic , Rochester, New York (K.D.F.); Department of Health Sciences Research , Mayo Clinic , Rochester, New York (D.J.J., J.S.); Department of Neurosurgery , Mayo Clinic , Rochester, New York (B.E.P., M.J.L.); Department of Endocrinology, Metabolism and Nutrition , Mayo Clinic , Rochester, New York (D.E.).
authors.forename: Jennifer
authors.initials: J
authors.lastname: St Sauver
authors.affiliation: Department of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston, Texas (P.D.B.); Department of Radiation Oncology , Mayo Clinic , Rochester, New York (P.D.B., M.B., C.A.B., R.W.K., B.E.P., Y.I.G., S.L.S., R.L.F., N.N.I.L.); School of Medicine and Health Sciences, University of North Dakota , Grand Forks, North Dakota (K.J.); Department of Neurology , Mayo Clinic , Rochester, New York (K.D.F.); Department of Health Sciences Research , Mayo Clinic , Rochester, New York (D.J.J., J.S.); Department of Neurosurgery , Mayo Clinic , Rochester, New York (B.E.P., M.J.L.); Department of Endocrinology, Metabolism and Nutrition , Mayo Clinic , Rochester, New York (D.E.).
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Pollock
authors.affiliation: Department of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston, Texas (P.D.B.); Department of Radiation Oncology , Mayo Clinic , Rochester, New York (P.D.B., M.B., C.A.B., R.W.K., B.E.P., Y.I.G., S.L.S., R.L.F., N.N.I.L.); School of Medicine and Health Sciences, University of North Dakota , Grand Forks, North Dakota (K.J.); Department of Neurology , Mayo Clinic , Rochester, New York (K.D.F.); Department of Health Sciences Research , Mayo Clinic , Rochester, New York (D.J.J., J.S.); Department of Neurosurgery , Mayo Clinic , Rochester, New York (B.E.P., M.J.L.); Department of Endocrinology, Metabolism and Nutrition , Mayo Clinic , Rochester, New York (D.E.).
authors.forename: Yolanda I
authors.initials: YI
authors.lastname: Garces
authors.affiliation: Department of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston, Texas (P.D.B.); Department of Radiation Oncology , Mayo Clinic , Rochester, New York (P.D.B., M.B., C.A.B., R.W.K., B.E.P., Y.I.G., S.L.S., R.L.F., N.N.I.L.); School of Medicine and Health Sciences, University of North Dakota , Grand Forks, North Dakota (K.J.); Department of Neurology , Mayo Clinic , Rochester, New York (K.D.F.); Department of Health Sciences Research , Mayo Clinic , Rochester, New York (D.J.J., J.S.); Department of Neurosurgery , Mayo Clinic , Rochester, New York (B.E.P., M.J.L.); Department of Endocrinology, Metabolism and Nutrition , Mayo Clinic , Rochester, New York (D.E.).
authors.forename: Scott L
authors.initials: SL
authors.lastname: Stafford
authors.affiliation: Department of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston, Texas (P.D.B.); Department of Radiation Oncology , Mayo Clinic , Rochester, New York (P.D.B., M.B., C.A.B., R.W.K., B.E.P., Y.I.G., S.L.S., R.L.F., N.N.I.L.); School of Medicine and Health Sciences, University of North Dakota , Grand Forks, North Dakota (K.J.); Department of Neurology , Mayo Clinic , Rochester, New York (K.D.F.); Department of Health Sciences Research , Mayo Clinic , Rochester, New York (D.J.J., J.S.); Department of Neurosurgery , Mayo Clinic , Rochester, New York (B.E.P., M.J.L.); Department of Endocrinology, Metabolism and Nutrition , Mayo Clinic , Rochester, New York (D.E.).
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Link
authors.affiliation: Department of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston, Texas (P.D.B.); Department of Radiation Oncology , Mayo Clinic , Rochester, New York (P.D.B., M.B., C.A.B., R.W.K., B.E.P., Y.I.G., S.L.S., R.L.F., N.N.I.L.); School of Medicine and Health Sciences, University of North Dakota , Grand Forks, North Dakota (K.J.); Department of Neurology , Mayo Clinic , Rochester, New York (K.D.F.); Department of Health Sciences Research , Mayo Clinic , Rochester, New York (D.J.J., J.S.); Department of Neurosurgery , Mayo Clinic , Rochester, New York (B.E.P., M.J.L.); Department of Endocrinology, Metabolism and Nutrition , Mayo Clinic , Rochester, New York (D.E.).
authors.forename: Dana
authors.initials: D
authors.lastname: Erickson
authors.affiliation: Department of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston, Texas (P.D.B.); Department of Radiation Oncology , Mayo Clinic , Rochester, New York (P.D.B., M.B., C.A.B., R.W.K., B.E.P., Y.I.G., S.L.S., R.L.F., N.N.I.L.); School of Medicine and Health Sciences, University of North Dakota , Grand Forks, North Dakota (K.J.); Department of Neurology , Mayo Clinic , Rochester, New York (K.D.F.); Department of Health Sciences Research , Mayo Clinic , Rochester, New York (D.J.J., J.S.); Department of Neurosurgery , Mayo Clinic , Rochester, New York (B.E.P., M.J.L.); Department of Endocrinology, Metabolism and Nutrition , Mayo Clinic , Rochester, New York (D.E.).
authors.forename: Robert L
authors.initials: RL
authors.lastname: Foote
authors.affiliation: Department of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston, Texas (P.D.B.); Department of Radiation Oncology , Mayo Clinic , Rochester, New York (P.D.B., M.B., C.A.B., R.W.K., B.E.P., Y.I.G., S.L.S., R.L.F., N.N.I.L.); School of Medicine and Health Sciences, University of North Dakota , Grand Forks, North Dakota (K.J.); Department of Neurology , Mayo Clinic , Rochester, New York (K.D.F.); Department of Health Sciences Research , Mayo Clinic , Rochester, New York (D.J.J., J.S.); Department of Neurosurgery , Mayo Clinic , Rochester, New York (B.E.P., M.J.L.); Department of Endocrinology, Metabolism and Nutrition , Mayo Clinic , Rochester, New York (D.E.).
authors.forename: Nadia N I
authors.initials: NN
authors.lastname: Laack
keywords: pituitary adenoma; radiotherapy; secondary malignancy; stroke; surgery