Impact of sex on mortality in patients with pituitary adenomas.

PURPOSE: Pituitary adenomas are increasingly diagnosed, with prolactinomas and non-functioning pituitary adenomas (NFPA) representing the large majority. Though most pituitary adenomas are indolent and very few are aggressive overall, mortality rates are higher than in general population. This varies with the type of pituitary adenoma, with the highest standardized mortality ratios in patients with Cushing’s disease (CD). Notably, sex differences in mortality remain controversial for all pituitary adenomas. METHODS: A scoping PubMed literature review with studies published in English from 1970 to 2025. RESULTS: Several studies are contradictory, most likely related to methodological variability. Data shows a general trend of higher mortality in women with acromegaly compared to men, particularly in newer studies. There are inconsistent results regarding sex-related differences in mortality among patients with CD, but excess mortality was observed in male patients with CD. Mortality is not well studied in prolactinomas given their generally benign course and studies on sex differences are lacking. Women with NFPA also seem to have excess mortality. Factors explaining the sex differences are not clear for any pituitary adenoma type. CONCLUSION: Though there seems to be a sex impact on mortality rates in pituitary adenomas, most data are conflicting. Prospective studies are needed in order to identify and address predictive factors for mortality differences between sexes.