title: Time trends of mortality in patients with non-functioning pituitary adenoma: a Swedish nationwide study.
abstract: OBJECTIVE
  Patients with non-functioning pituitary adenomas (NFPA), especially women, have increased mortality. The aim of this study was to investigate whether mortality in NFPA patients has changed during the last two decades.
  
  
  METHODS
  This was a nationwide population-based study including 2795 patients (1502 men, 1293 women) diagnosed with NFPA between 1997 and 2011. Patients were identified and followed in Swedish National Health Registries. Standardized mortality ratios (SMRs) with 95 % confidence intervals were calculated for three time periods at first NFPA diagnosis using the general population as reference.
  
  
  RESULTS
  Mean (±SD) age at NFPA diagnosis was 58.9 ± 16.8 years. Mean (range) follow-up time was 8.3 (0-18) years, resulting in 20,517 patient-years at risk. Surgical treatment and radiotherapy were used in 53 and 5 %, respectively. The prevalence of hypopituitarism was 64 % during the first time period of diagnosis and then declined gradually during the study period (P value for trend <0.0001). The use of pituitary surgery and radiotherapy remained stable. In women, mortality was increased for patients diagnosed between 1997 and 2006 but not for those diagnosed between 2007 and 2011. The SMR in men remained stable throughout the study and did not differ from the general population. During the last time period, 2007-2011, the SMR between men and women did not differ.
  
  
  CONCLUSIONS
  While mortality in men with NFPA remains normal and stable during the last two decades, mortality in women has declined. Decreasing prevalence of pituitary insufficiency may be a plausible explanation for this positive development.
authors.affiliation: Department of Endocrinology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gröna Stråket 8, 413 45, Gothenburg, Sweden. daniel.olsson@gu.se.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Olsson
authors.affiliation: Department of Occupational and Environmental Medicine, Örebro University Hospital, 701 85, Örebro, Sweden.
authors.forename: Ing-Liss
authors.initials: IL
authors.lastname: Bryngelsson
authors.affiliation: Department of Endocrinology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gröna Stråket 8, 413 45, Gothenburg, Sweden.
authors.forename: Oskar
authors.initials: O
authors.lastname: Ragnarsson
mesh_terms: D000236:Adenoma / Q000453:epidemiology / Q000401:mortality; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007018:Hypopituitarism / Q000453:epidemiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000453:epidemiology / Q000401:mortality*; D015995:Prevalence; D013548:Sweden / Q000453:epidemiology
keywords: Hypopituitarism; Mortality; Non-functioning pituitary adenoma; Surgery; Time trends; Women