Monday, January 25, 2010

Mortality in Patients with Pituitary Disease

Mark Sherlock, John Ayuk, Jeremy W. Tomlinson, Andrew A. Toogood, Aurora Aragon-Alonso, Michael C. Sheppard, Andrew S. Bates,  and Paul M. Stewart*

Centre for Endocrinology, Diabetes, and Metabolism (M.S., J.A., J.W.T., A.A.T., A.A.-A., M.C.S., P.M.S.), School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TH, United Kingdom; and Birmingham Heartlands and Solihull National Health Service Trust (A.S.B.), Birmingham B9 5SS, United Kingdom

* To whom correspondence should be addressed. E-mail: P.M.Stewart@bham.ac.uk.

Pituitary disease is associated with increased mortality predominantly due to vascular disease. Control of cortisol secretion and GH hypersecretion (and cardiovascular risk factor reduction) is key in the reduction of mortality in patients with Cushing's disease and acromegaly, retrospectively.

For patients with acromegaly, the role of IGF-I is less clear-cut. Confounding pituitary hormone deficiencies such as gonadotropins and particularly ACTH deficiency (with higher doses of hydrocortisone replacement) may have a detrimental effect on outcome in patients with pituitary disease. Pituitary radiotherapy is a further factor that has been associated with increased mortality (particularly cerebrovascular). Although standardized mortality ratios in pituitary disease are falling due to improved treatment, mortality for many conditions are still elevated above that of the general population, and therefore further measures are needed.

Craniopharyngioma patients have a particularly increased risk of mortality as a result of the tumor itself and treatment to control tumor growth; this is a key area for future research in order to optimize the outcome for these patients.

From http://edrv.endojournals.org/cgi/content/abstract/er.2009-0033v1