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Comparative mortality in pituitary adenomas subtypes: a tertiary referral center study
Iustin Daniel Toma1,2, Dan Alexandru Niculescu3,4, Simona Andreea Găloiu1,2
1Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
Endocrine
|October 19, 2024
Summary
Mortality risk in pituitary adenomas (PAs) varies by subtype, especially in older adults. Cushing's disease (CD) patients over 45 face higher mortality than other PA subtypes within 15 years.
Area of Science:
- Endocrinology
- Oncology
- Neurosurgery
Background:
- Pituitary adenomas (PAs) are common tumors with established mortality comparisons to the general population.
- Direct comparative mortality data between distinct PA subtypes remain limited.
Purpose of the Study:
- To compare mortality rates across different pituitary adenoma subtypes: acromegaly, Cushing's disease (CD), macroprolactinomas, and non-functioning pituitary macroadenomas (MacroNFPA).
- To investigate survival differences within a single referral center cohort.
Main Methods:
- Retrospective analysis of 962 PA patients diagnosed between 2011 and 2023.
- Categorization into acromegaly (n=306), CD (n=69), macroprolactinoma (n=168), and MacroNFPA (n=419).
- Assessment of mortality and survival time with a median follow-up of 10.2 years.
Main Results:
- Overall 10- and 20-year survival probabilities were 90.9% and 78.1%, respectively; age at diagnosis was the sole significant predictor in the overall cohort.
- No significant survival differences were observed between PA subtypes in the entire cohort.
- In patients diagnosed over 45 years old, significant survival differences emerged within the first 15 years (p=0.01). Cushing's disease showed a 3.38-fold higher mortality risk compared to acromegaly, even after adjusting for age and sex.
Conclusions:
- Cushing's disease patients diagnosed after age 45 exhibit significantly lower survival rates within the initial 15 years compared to other PA subtypes.
- Survival probabilities for other PA subtypes were comparable after adjusting for age and sex.
- Future PA mortality may be increasingly influenced by tumor mass rather than hormonal hypersecretion, due to therapeutic advancements.
