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Increased cerebrovascular mortality in patients with hypopituitarism
Insights
Patients with hypopituitarism face higher risks of death from cerebrovascular disease, particularly women and those diagnosed younger. This highlights the need for careful monitoring and treatment in this population.
Area of Science:
- Endocrinology
- Cardiovascular Epidemiology
- Neurosurgery Outcomes
Background:
- Hypopituitarism is associated with increased atherosclerosis.
- Cardiovascular mortality risks in hypopituitary patients require further investigation.
Purpose of the Study:
- To evaluate the cardiovascular and cerebrovascular mortality rates in patients with hypopituitarism.
Main Methods:
- Retrospective cohort study (1952-1992) of 344 hypopituitary patients treated for pituitary tumors.
- Comparison of mortality data against the general population of southern Sweden.
- Analysis of mortality by cause, sex, age, and time since diagnosis.
Main Results:
- Significantly increased overall cardiovascular mortality (SMR 1.75), driven by cerebrovascular disease (SMR 3.39).
- Higher risk of cerebrovascular death observed in women (SMR 4.91) compared to men (SMR 2.64).
- Increased risk was associated with earlier age at diagnosis (< 55 years).
Conclusions:
- Elevated cerebrovascular mortality in hypopituitarism may be linked to growth hormone deficiency or inadequate hormone replacement.
- Early onset of pituitary insufficiency and female sex are key predictors of increased cerebrovascular mortality risk.
- These findings emphasize the need for targeted monitoring and management strategies for high-risk individuals with hypopituitarism.
Objective:
An increased prevalence of atherosclerosis has been shown among patients with hypopituitarism. The aim of the present study was to assess whether patients with hypopituitarism experience increased cardiovascular, in particular cerebrovascular, mortality.
Design And Patients:
Retrospective cohort study of mortality, 1952-1992, in 344 patients, of whom 130 were female, receiving conventional hormone replacement for hypopituitarism following neurosurgery for pituitary tumours. The general population in the catchment area of southern Sweden from which the patients were recruited constituted the reference population. Expected mortality was obtained from cause, sex, calendar year, and 5-year age-specific death raise for the area.
Results:
Increased mortality from cerebrovascular disease (standardized mortality ratio (SMR) 3.39; 95% CI 2.27-4.99) was the main contributor to the increased overall cardiovascular mortality (SMR 1.75; 95% CI 1.40-2.19). The increase in mortality from cardiac diseases was much smaller (SMR 1.41; 95% CI 1.04-1.88). The risk for cerebrovascular death was higher in women (SMR 4.91) than in men (SMR 2.64). The relative risk for cerebrovascular death was independent of the time interval since diagnosis of pituitary insufficiency, but was greater in subjects diagnosed at an earlier age (< 55 years). No increased mortality in malignant tumours was observed (SMR 0.95; 95% CI 0.60-1.48).
Conclusion:
The increased cerebrovascular mortality may be due to GH deficiency, or to long-term lack or inadequacy of substitution for other pituitary hormones. The observations that an early onset of pituitary insufficiency and female sex are predictors for a high risk for cerebrovascular mortality merit particular attention when treating this group of patients.