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Endocrine Abstracts (2012) 29 OC10.4

ICEECE2012 Oral Communications Pituitary Clinical 2 (6 abstracts)

Higher glucocorticoid supplementation doses are associated with increased overall mortality in patients with non-functioning pituitary adenoma

T. Zueger 1 , P. Kirchner 1 , C. Herren 1 , S. Allemann 1, , S. Fischli 3 , M. Zwahlen 2 , E. Christ 1 & C. Stettler 1


1Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland; 2University of Bern, Bern, Switzerland; 3Kantonsspital Lucerne, Lucerne, Switzerland.


Introduction: Current treatment guidelines for patients with insufficiency of the hypothalamic pituitary adrenal (HPA) axis recommend weight adjusted glucocorticoid supplementation doses to minimize risk of negative side effects (e.g. osteoporosis etc).

However, little is known on a potential dose-dependent effect of glucocorticoid supplementation on overall mortality in patients with pituitary disease. Non-functioning pituitary adenoma (NFPA) is one of the most frequent sellar pathologies. Therefore, the present study aimed at assessing whether higher glucocorticoid supplementation doses were associated with increased mortality in individuals with NFPA and HPA insufficiency.

Methods/Design: We included 105 patients (29 female, 76 male) referred to our tertiary Endocrine referral center after pituitary surgery due to NFPA and with glucocorticoid supplementation due to HPA insufficiency; 101 individuals with NFPA but without HPA insufficiency were included as comparators. Status (alive/death) and date of death were assessed per end of 2010. Mortality was assessed using Kaplan Meier methodology as well as Cox regression analysis with adjustments for age, body-weight and gender.

Results: Average age at inclusion was 57.6±15.0 years, mean follow-up was 10.8±8.2 years, mean hydrocortisone (HC) equivalent dose at follow-up was 22±13.1 mg. Kaplan Meier survival probabilities differed significantly when comparing individuals with differing absolute HC dose (none, 5–19, 20–29, ≥30 mg, P=0.011) as well as using weight-adjusted doses (P=0.047). This result persisted when analyses were adjusted for age, weight, and gender with hazard ratios increasing from 1 (5–19 mg) to 1.36 (20–29 mg), and to 2.67 (≥30 mg, P for trend 0.036).

Conclusions: Higher glucocorticoid supplementation doses are associated with increased overall mortality in patients with NFPA and insufficiency of HPA axis. This further substantiates the importance of a balanced and adjusted glucocorticoid replacement therapy in these patients.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

Volume 29

15th International & 14th European Congress of Endocrinology

European Society of Endocrinology 

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