The Journal of clinical endocrinology and metabolism · 2012
Glucocorticoid replacement and mortality in patients with nonfunctioning pituitary adenoma.
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Zueger Thomas, Kirchner Paul, Herren Coline, Fischli Stefan, Zwahlen Marcel, Christ Emanuel, Stettler Christoph
Аннотация
CONTEXT: Current treatment guidelines generally suggest using lower and weight-adjusted glucocorticoid replacement doses in patients with insufficiency of the hypothalamic-pituitary-adrenal (HPA) axis. Although data in patients with acromegaly revealed a positive association between glucocorticoid dose and mortality, no comparable results exist in patients with nonfunctioning pituitary adenomas (NFPA).
OBJECTIVE: Our objective was to assess whether higher glucocorticoid replacement doses are associated with increased mortality in patients with NFPA and HPA axis insufficiency.
DESIGN, PARTICIPANTS, AND INTERVENTION: We included 105 patients receiving glucocorticoid replacement after pituitary surgery due to NFPA and concomitant HPA axis insufficiency. Patients were grouped according weight-adapted and absolute hydrocortisone (HC) replacement doses. Mortality was assessed using Kaplan-Meier methodology as well as multivariable Cox regression models.
SETTING: This was a retrospective analysis conducted at a tertiary referral center.
MAIN OUTCOME: We evaluated overall mortality based on HC replacement doses.
RESULTS: Average age at inclusion was 58.9±14.8 yr, and mean follow-up was 12.7±9.4 yr. The groups did not differ according to age, follow-up time, pattern of hypopituitarism, and comorbidities. Kaplan-Meier survival probabilities differed significantly when comparing individuals with differing weight-adjusted HC dose (P=0.001) as well as absolute HC dose (5-19, 20-29, and ≥30 mg, P=0.009). Hazard ratios for mortality increased from 1 (0.05-0.24 mg/kg) to 2.62 (0.25-0.34 mg/kg) to 4.56 (≥0.35 mg/kg, P for trend=0.006) and from 1 (5-19 mg) to 2.03 (20-29 mg) to 4 (≥30 mg, P for trend=0.029), respectively.
CONCLUSION: Higher glucocorticoid replacement doses are associated with increased overall mortality in patients with NFPA and insufficiency of HPA axis. This further substantiates the importance of a balanced and adjusted glucocorticoid replacement therapy in these patients.
OBJECTIVE: Our objective was to assess whether higher glucocorticoid replacement doses are associated with increased mortality in patients with NFPA and HPA axis insufficiency.
DESIGN, PARTICIPANTS, AND INTERVENTION: We included 105 patients receiving glucocorticoid replacement after pituitary surgery due to NFPA and concomitant HPA axis insufficiency. Patients were grouped according weight-adapted and absolute hydrocortisone (HC) replacement doses. Mortality was assessed using Kaplan-Meier methodology as well as multivariable Cox regression models.
SETTING: This was a retrospective analysis conducted at a tertiary referral center.
MAIN OUTCOME: We evaluated overall mortality based on HC replacement doses.
RESULTS: Average age at inclusion was 58.9±14.8 yr, and mean follow-up was 12.7±9.4 yr. The groups did not differ according to age, follow-up time, pattern of hypopituitarism, and comorbidities. Kaplan-Meier survival probabilities differed significantly when comparing individuals with differing weight-adjusted HC dose (P=0.001) as well as absolute HC dose (5-19, 20-29, and ≥30 mg, P=0.009). Hazard ratios for mortality increased from 1 (0.05-0.24 mg/kg) to 2.62 (0.25-0.34 mg/kg) to 4.56 (≥0.35 mg/kg, P for trend=0.006) and from 1 (5-19 mg) to 2.03 (20-29 mg) to 4 (≥30 mg, P for trend=0.029), respectively.
CONCLUSION: Higher glucocorticoid replacement doses are associated with increased overall mortality in patients with NFPA and insufficiency of HPA axis. This further substantiates the importance of a balanced and adjusted glucocorticoid replacement therapy in these patients.
Предметные рубрики MeSH
AdenomaAdultAgedComorbidityDose-Response Relationship, DrugFemaleFollow-Up StudiesGlucocorticoidsGrowth Hormone-Secreting Pituitary AdenomaHumansHydrocortisoneHypothalamo-Hypophyseal SystemKaplan-Meier EstimateMaleMiddle AgedPituitary NeoplasmsPituitary-Adrenal SystemRetrospective StudiesTertiary Care Centers