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Endocrine Abstracts (2016) 41 OC13.3 | DOI: 10.1530/endoabs.41.OC13.3

ECE2016 Oral Communications Pituitary Clinical (5 abstracts)

Increased glucocorticoid replacement doses are associated with excess mortality in patients with non-functioning pituitary adenoma

Casper Hammarstrand 1 , Tobias Hallén 2 , Eva Andersson 3 , Thomas Skoglund 2 , Anna G Nilsson 1 , Oskar Ragnarsson 1 , Gudmundur Johannsson 1 & Daniel S Olsson 1

1Sahlgrenska University Hospital, Department of Endocrinology, Gothenburg, Sweden; 2Sahlgrenska University Hospital, Department of Neurosurgery, Gothenburg, Sweden; 3Sahlgrenska University Hospital, Department of Occupational and Environmental Medicine, Gothenburg, Sweden.

Background: Patients with secondary adrenal insufficiency have an excess mortality. Data concerning the influence of the glucocorticoid replacement regime on mortality is sparse.

Objective: To investigate if the total daily dose of glucocorticoid replacement has an effect on mortality in patients with non-functioning pituitary adenoma (NFPA).

Method: Patients with NFPA treated for hypopituitarism in the western region of Sweden were retrospectively analysed. Patients were cross-referenced with the Swedish National Death Registry. Cox-regression analyses with 95% confidence intervals (CI) were used to identify predictors for mortality. Patients were sub-grouped depending on their total daily dose of hydrocortisone (HC) equivalents (156 patients with ≤20 mg HC; 50 patients with >20 mg HC). HC was used by 198 patients (96%) at last follow-up.

Results: A total of 405 patients (264 men, 141 women) with NFPA were identified. Mean (±SD) age at diagnosis was 58±15 years and mean follow-up time was 11±9 years. Treatment with radiotherapy was used in 75 patients (19%). Death occurred in 76 patients (51 patients with glucocorticoid replacement). Secondary adrenal insufficiency was found in 206 patients (151 men, 55 women), which received a mean daily HC equivalents dose of 21±8 mg. A cox-regression of the glucocorticoid replacement patients showed that age (Hazard ratio (HR) 1.14; 95% CI 1.10–1.19), diabetes insipidus (3.18; 1.50–6.74) and a daily HC equivalents dose of >20 mg (2.07; 1.13–3.77) had a negative effect on mortality, whereas body weight (0.99; 0.97–1.01) and treatment with radiotherapy (1.00; 0.45–2.22) did not. The HR for male gender was 1.75 (95% CI 0.83–3.68).

Conclusion: Daily HC replacement doses of more than 20 mg per day and the presence of diabetes insipidus are associated with increased mortality risk in patients with NFPA and secondary adrenal insufficiency.

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