FP26-3 Deaths Among Adult Patients With Hypopituitarism: Hypocortisolism During Acute Stress, and De Novo Malignant Brain Tumors Contribute to An Increased Mortality

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: FP26-Neuroendocrinology
Sunday, June 16, 2013: 10:45 AM-11:15 AM
Presentation Start Time: 10:55 AM
Room 130 (Moscone Center)

Poster Board SUN-132
Pia Burman*1, Anders F Mattson2, Gudmundur Johannsson3, Charlotte Hoybye4, Helen Holmer5, Per Dahlqvist6, Katarina Berinder7, Britt Eden Engstrom8, Bertil Ekman9, Eva Marie Erfurth10, Johan Svensson3, Jeanette Wahlberg9 and F Anders Karlsson11
1University Hospital, Malmö, 2Pfizer Health AB, Stockholm, 3Sahlgrenska Academy, Gothenburg, 4Karolinska University Hospital, Stockholm, 5Central Hospital, Kristianstad, 6University Hospital, Umeå, 7Karolinska Univiversity Hospital, Stockholm, 8University Hospital, Uppsala, 9University Hospital, Linköping, 10Univ Hosp, Lund, 11University Hospital, Uppsala, Sweden
Context Patients with hypopituitarism have an increased standardized mortality rate. The basis for this has not been fully clarified.

Objective To investigate in detail the cause of death in a large cohort of patients with hypopituitarism subjected to long-term follow-up.

Design and Methods All-cause- and cause-specific mortality in 1286 Swedish patients with hypopituitarism prospectively monitored in KIMS (Pfizer International Metabolic Database) 1995-2009 were compared to general population data in the Swedish National Cause of Death Registry. In addition, events reported in KIMS, medical records, and post-mortem reports were reviewed.

Main outcome measures Standardized mortality ratios (SMR) were calculated, with stratification for gender, attained age and calendar year during follow-up.

Results  An excess mortality was found, 120 deaths vs. 84.3 expected, SMR 1.42 (95% CI 1.18-1.70). Infections, brain cancer and sudden death were associated with significantly increased SMRs (6.32, 9.40, and 4.10, respectively). Fifteen patients, all ACTH deficient, died from infections. Eight of these patients were considered to be in a state of adrenal crisis in connection with death (medical reports and post-mortem examinations). Another 8 patients died from de novo malignant brain tumors, 6 of which had had a benign pituitary lesion at baseline. Six of these 8 subjects had received prior radiation therapy.

Conclusion Two important causes of excess mortality were identified. Firstly, adrenal crisis in response to acute stress and intercurrent illness. Secondly, increased risk of a late appearance of de novo malignant brain tumors in patients who previously received radiotherapy. Both of these causes may be in part preventable by changes in the management of pituitary disease.

Nothing to Disclose: PB, AFM, GJ, CH, HH, PD, KB, BE, BE, EME, JS, JW, FAK

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm

Sources of Research Support: This work was supported by a grant from the University of Lund. The  KIMS database is sponsored by Pfizer Inc.