title: Mortality in patients with non-functioning pituitary adenoma is increased: systematic analysis of 546 cases with long follow-up.
abstract: OBJECTIVE
  Non-functioning pituitary adenomas (NFAs) have a prevalence of 7-22/100,000 people. A significant number of patients suffer from morbidities related to the tumor, possible recurrence(s), and treatments utilized. Our aim was to assess mortality of patients with macroNFA and predictive factors.
  
  
  METHODS
  Retrospective cohort study in a tertiary referral center in the UK.
  
  
  METHODS
  A total of 546 patients operated for a macroNFA between 1963 and 2011 were studied. Mortality data were retrieved through the National Health Service Central Register and hospital records and recorded as standardized mortality ratio (SMR). Mortality was estimated for the total and various subgroups with clinical follow-up data.
  
  
  RESULTS
  Median follow-up was 8 years (range: 1 month-48.5 years). SMR was 3.6 (95% CI, 2.9-4.5), for those operated before 1990, 4.7 (95% CI, 2.7-7.6) and for those after 1990, 3.5 (95% CI, 2.8-4.4). Main causes of death were cardio/cerebrovascular (33.7%), infections (30.1%), and malignancy (28.9%). Cox regression analysis demonstrated that only age at diagnosis remained an independent predictor of mortality (hazard ratio 1.10; 95% CI, 1.07-1.13, P<0.001), whereas sex, presentation with acute apoplexy, extent of tumor removal, radiotherapy, recurrence, untreated GH deficiency, FSH/LH deficiency, ACTH deficiency, TSH deficiency, and treatment with desmopressin had no impact.
  
  
  CONCLUSIONS
  Despite the improvement of treatments over the last three decades, the mortality of patients with NFAs in our series remains high. Apart from age, factors related with the management/outcome of the tumor are not independent predictors, and pituitary hormone deficits managed with the currently-used substitution protocols do not adversely affect mortality.
authors.affiliation: Department of EndocrinologyOxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, UKDepartments of NeuroradiologyNeurosurgeryJohn Radcliffe Hospital, Oxford, UKSchool of Clinical and Experimental MedicineInstitute of Metabolism and Systems Research, University of Birmingham, Wolfson Drive, Edgbaston, Birmingham B15 2TT, UK.
authors.forename: Georgia
authors.initials: G
authors.lastname: Ntali
authors.affiliation: Department of EndocrinologyOxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, UKDepartments of NeuroradiologyNeurosurgeryJohn Radcliffe Hospital, Oxford, UKSchool of Clinical and Experimental MedicineInstitute of Metabolism and Systems Research, University of Birmingham, Wolfson Drive, Edgbaston, Birmingham B15 2TT, UK.
authors.forename: Cristina
authors.initials: C
authors.lastname: Capatina
authors.affiliation: Department of EndocrinologyOxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, UKDepartments of NeuroradiologyNeurosurgeryJohn Radcliffe Hospital, Oxford, UKSchool of Clinical and Experimental MedicineInstitute of Metabolism and Systems Research, University of Birmingham, Wolfson Drive, Edgbaston, Birmingham B15 2TT, UK.
authors.forename: Violet
authors.initials: V
authors.lastname: Fazal-Sanderson
authors.affiliation: Department of EndocrinologyOxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, UKDepartments of NeuroradiologyNeurosurgeryJohn Radcliffe Hospital, Oxford, UKSchool of Clinical and Experimental MedicineInstitute of Metabolism and Systems Research, University of Birmingham, Wolfson Drive, Edgbaston, Birmingham B15 2TT, UK.
authors.forename: James V
authors.initials: JV
authors.lastname: Byrne
authors.affiliation: Department of EndocrinologyOxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, UKDepartments of NeuroradiologyNeurosurgeryJohn Radcliffe Hospital, Oxford, UKSchool of Clinical and Experimental MedicineInstitute of Metabolism and Systems Research, University of Birmingham, Wolfson Drive, Edgbaston, Birmingham B15 2TT, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Cudlip
authors.affiliation: Department of EndocrinologyOxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, UKDepartments of NeuroradiologyNeurosurgeryJohn Radcliffe Hospital, Oxford, UKSchool of Clinical and Experimental MedicineInstitute of Metabolism and Systems Research, University of Birmingham, Wolfson Drive, Edgbaston, Birmingham B15 2TT, UK.
authors.forename: Ashley B
authors.initials: AB
authors.lastname: Grossman
authors.affiliation: Department of EndocrinologyOxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, UKDepartments of NeuroradiologyNeurosurgeryJohn Radcliffe Hospital, Oxford, UKSchool of Clinical and Experimental MedicineInstitute of Metabolism and Systems Research, University of Birmingham, Wolfson Drive, Edgbaston, Birmingham B15 2TT, UK.
authors.forename: John A H
authors.initials: JA
authors.lastname: Wass
authors.affiliation: Department of EndocrinologyOxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, UKDepartments of NeuroradiologyNeurosurgeryJohn Radcliffe Hospital, Oxford, UKSchool of Clinical and Experimental MedicineInstitute of Metabolism and Systems Research, University of Birmingham, Wolfson Drive, Edgbaston, Birmingham B15 2TT, UK Department of EndocrinologyOxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, UKDepartments of NeuroradiologyNeurosurgeryJohn Radcliffe Hospital, Oxford, UKSchool of Clinical and Experimental MedicineInstitute of Metabolism and Systems Research, University of Birmingham, Wolfson Drive, Edgbaston, Birmingham B15 2TT, UK n.karavitaki@bham.ac.uk.
authors.forename: Niki
authors.initials: N
authors.lastname: Karavitaki
mesh_terms: D000236:Adenoma / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery; D012042:Registries / Q000706:statistics & numerical data*; D006113:United Kingdom / Q000453:epidemiology