Higher glucocorticoid replacement doses are associated with increased mortality in patients with pituitary adenoma
| Autor: | Casper Hammarstrand, Eva Andersson, Anna G Nilsson, Oskar Ragnarsson, Tobias Hallén, Thomas Skoglund, Gudmundur Johannsson, Daniel S Olsson |
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| Rok vydání: | 2017 |
| Předmět: |
Adenoma
Adult Male medicine.medical_specialty Endocrinology Diabetes and Metabolism Population 030209 endocrinology & metabolism Hypopituitarism Pituitary neoplasm Cohort Studies 03 medical and health sciences 0302 clinical medicine Endocrinology Internal medicine medicine Humans Pituitary Neoplasms Registries 030212 general & internal medicine Mortality education Glucocorticoids Aged Hydrocortisone Sweden education.field_of_study Dose-Response Relationship Drug business.industry General Medicine Middle Aged medicine.disease Confidence interval Standardized mortality ratio Female business Glucocorticoid Follow-Up Studies medicine.drug |
| Zdroj: | European Journal of Endocrinology. 177:251-256 |
| ISSN: | 1479-683X 0804-4643 |
| DOI: | 10.1530/eje-17-0340 |
| Popis: | Objective Patients with secondary adrenal insufficiency (AI) have an excess mortality. The objective was to investigate the impact of the daily glucocorticoid replacement dose on mortality in patients with hypopituitarism due to non-functioning pituitary adenoma (NFPA). Methods Patients with NFPA were followed between years 1997 and 2014 and cross-referenced with the National Swedish Death Register. Standardized mortality ratio (SMR) was calculated with the general population as reference and Cox-regression was used to analyse the mortality. Results The analysis included 392 patients (140 women) with NFPA. Mean ± s.d. age at diagnosis was 58.7 ± 14.6 years and mean follow-up was 12.7 ± 7.2 years. AI was present in 193 patients, receiving a mean daily hydrocortisone equivalent (HCeq) dose of 20 ± 6 mg. SMR (95% confidence interval (CI)) for patients with AI was similar to that for patients without, 0.88 (0.68–1.12) and 0.87 (0.63–1.18) respectively. SMR was higher for patients with a daily HCeq dose of >20 mg (1.42 (0.88–2.17)) than that in patients with a daily HCeq dose of 20 mg (0.71 (0.49–0.99)), P = 0.017. In a Cox-regression analysis, a daily HCeq dose of >20 mg was independently associated with a higher mortality (HR: 1.88 (1.06–3.33)). Patients with daily HCeq doses of ≤20 mg had a mortality risk comparable to patients without glucocorticoid replacement and to the general population. Conclusion Patients with NFPA and AI receiving more than 20 mg HCeq per day have an increased mortality. Our data also show that mortality in patients substituted with 20 mg HCeq per day or less is not increased. |
| Databáze: | OpenAIRE |
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