Mortality and survival in a large series of adult patients with hypopituitarism followed for 10 years
E. Fernandez-Rodriguez1, M. Lopez-Raton2, C. Cadarso2, F. Casanueva1,3 & I. Bernabeu1
Hypopituitarism is associated with increased morbidity and mortality compared to healthy population. However, the factors influencing prognosis are still not well known.
Objectives: To determine the causes of mortality in adult patients with hypopituitarism and compare the mortality rate with general population
To identify the factors associated with mortality and survival.
Patients: Two hundred and nine adult patients followed because of hypopituitarism during a 10-year period.
Results: The most frequent cause of hypopituitarism was a pituitary or peri-pituitary tumour (55.5%), 87.3% operated and 61% irradiated. FSH/LH was the most frequent deficiency (80.4%), followed by TSH (72.2%), ACTH (60.3%), GH (60.3%) and ADH (19.6%).
Prevalence of obesity was 44.8% (BMI) and 56.6% (waist circumference). 15.4% had diabetes (59.3% well controlled), 34.3% hypertension and 38.8% dyslipidemia. Cardiovascular, chronic respiratory, cerebrovascular disease and malignancy were diagnosed in 16.9, 2.5, 4.8 and 7.2% respectively.
Thirty-two patients died due to cardiovascular disease (46.8%), infections (28.1%), malignancy (15.6%) and cerebrovascular disease (9.4%). Standardized mortality rate was 8.05, higher in males (8.92 vs 7.43) and young patients (84.93 vs 5.26). Previous radiotherapy (P=0.02), acromegaly (P=0.033), higher BMI (P=0.04) or waist circumference (P=0.032), diabetes (P=0.03), uncontrolled diabetes (P=0.026) and cancer (P<0.0001) were associated with mortality.
Stepwise multivariate analysis showed that reduced life expectancy was related to older age, previous radiotherapy, uncontrolled diabetes and malignancy, while tumoral causes prolonged survival.
Discussion: Mortality in these patients was eight times higher than general population. Lower survival since diagnosis was related to older age, non-tumoral causes, malignancy, uncontrolled diabetes and previous radiotherapy. Diagnosis of acromegaly, higher BMI and waist circumference were related to mortality, although in these cases differences in survival were not detected.
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.