Epidemiology, mortality rate and survival in a homogeneous population of hypopituitary patients

Abstract

Introduction: Hypopituitarism is associated with higher prevalence of cardiovascular risk factors and premature death. Furthermore, some clinical and therapeutic features of hypopituitarism have been associated with a worse prognosis.

Objective: We reviewed, retrospectively, a large series of adult patients with hypopituitarism using stringent epidemiological criteria. Prevalence, association with cardiovascular risk factors, mortality and survival have been analysed.

Design and methods: Two hundred and nine adult hypopituitary patients (56·9% females) from a population of 405 218 inhabitants, followed for 10 years.

Results: Prevalence of hypopituitarism at the end of the study was 37·5 cases/100 000 inhabitants. Incidence of hypopituitarism was 2·07 cases/100 000 inhabitants and year. Thirty-two patients died during the period of the study. Standardized mortality rate (SMR) was 8·05, higher in males (8·92 vs 7·34) and in younger patients (84·93 vs 5·26). Diagnosis of acromegaly (P = 0·033), previous radiotherapy (P = 0·02), higher BMI (P = 0·04), diabetes mellitus (P = 0·03) and cancer (P < 0·0001) were associated with mortality. A lower survival was associated with older age at diagnosis, nontumoural causes, previous radiotherapy, diabetes mellitus with poor metabolic control and malignant disease.

Conclusions: Prevalence of hypopituitarism was 37·5 cases/100 000 inhabitants, and annual incidence was 2·07 cases/100 000 inhabitants. SMR was 8 times higher in hypopituitarism than in general population and was also higher in males and younger patients. Reduced survival was significantly related to cancer, nontumoural causes of hypopituitarism, older age at diagnosis, previous radiotherapy and diabetes mellitus with poor metabolic control.