title: Life expectancy in patients with pituitary adenoma receiving growth hormone replacement.
abstract: OBJECTIVE
  Hypopituitarism has been associated with increased mortality. The excess mortality may be due to untreated growth hormone (GH) deficiency but also due to various underlying disorders. We therefore analysed mortality in patients with only one underlying disorder, non-functioning pituitary adenoma (NFPA), with and without GH replacement therapy (GHRT).
  
  
  METHODS
  Patients with NFPA in the western region of Sweden, 1997-2011, were identified through the National Patient Registry and cross-referenced with several National Health Registries. All patient records were reviewed. Standardised mortality ratios (SMRs) with 95% confidence intervals (CIs) were calculated using the general population as reference. Cox-regression models were performed to identify predictors of mortality.
  
  
  RESULTS
  A total of 426 NFPA patients with 4599 patient-years were included, of whom 207 had used GHRT and 219 had not received GHRT. Median (range) follow-up in patients with and without GHRT was 12.2 (0-25) and 8.2 (0-27) years, respectively. Other pituitary hormone deficiencies were more frequent in the GHRT group than those in the non-GHRT group. SMR was 0.65 (95% CI, 0.44-0.94; P = 0.018) for the GHRT group and 1.16 (0.94-1.42; P = 0.17) for the non-GHRT group. Direct comparison between the groups showed reduced mortality among those who were GH replaced (P = 0.0063). The SMR for malignant tumours was reduced in the GHRT-group (0.29; 0.08-0.73; P = 0.004) but not in untreated patients.
  
  
  CONCLUSIONS
  Selection bias explaining some of the results cannot be excluded. However, NFPA patients with GHRT had reduced overall mortality compared with the general population, and death due to malignancy was not increased. This suggests that long-term GHRT is safe in adult patients selected for treatment.
authors: Department of EndocrinologyInstitute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Göteborg, Sweden daniel.olsson@gu.se.
authors: Daniel S
authors: DS
authors: Olsson
authors: Department of EndocrinologyInstitute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Göteborg, Sweden.
authors: Penelope
authors: P
authors: Trimpou
authors: Department of NeurosurgerySahlgrenska University Hospital, Göteborg, Sweden.
authors: Tobias
authors: T
authors: Hallén
authors: Department of Occupational and Environmental MedicineÖrebro University Hospital, Örebro, Sweden.
authors: Ing-Liss
authors: IL
authors: Bryngelsson
authors: Department of Occupational and Environmental MedicineSahlgrenska University Hospital, Göteborg, Sweden.
authors: Eva
authors: E
authors: Andersson
authors: Department of NeurosurgerySahlgrenska University Hospital, Göteborg, Sweden.
authors: Thomas
authors: T
authors: Skoglund
authors: Department of EndocrinologyInstitute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Göteborg, Sweden.
authors: Bengt-Åke
authors: BÅ
authors: Bengtsson
authors: Department of EndocrinologyInstitute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Göteborg, Sweden.
authors: Gudmundur
authors: G
authors: Johannsson
authors: Department of EndocrinologyInstitute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Göteborg, Sweden.
authors: Anna G
authors: AG
authors: Nilsson
mesh_terms: D000368:Aged; D005260:Female; D013006:Growth Hormone / Q000627:therapeutic use*; D020249:Hormone Replacement Therapy / Q000009:adverse effects; D006801:Humans; D007018:Hypopituitarism / Q000188:drug therapy*; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000188:drug therapy* / Q000401:mortality
chemical_list: D013006:Growth Hormone