Mortality of patients with non-functioning pituitary macroadenoma is significantly elevated: systematic analysis of 546 cases in a tertiary referral centre in the UK

Mortality of patients with non-functioning pituitary macroadenoma is significantly elevated: systematic analysis of 546 cases in a tertiary referral centre in the UK Georgia Ntali1, Cristina Capatina1, Violet Fazal-Sanderson1, James V Byrne2, Simon Cudlip3, John A H Wass1, Ashley B Grossman1 & Niki Karavitaki1 1Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, UK; 2Department of Neuroradiology, John Radcliffe Hospital, Oxford, UK; 3Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK. Introduction Data on the mortality of patients with non-functioning pituitary macroadenoma (NFA) are limited. Aim: To assess the mortality of patients with NFA and predictive factors. Patients/methods All patients presenting to our Department with NFA between 1963 and 2011 were studied. Status was recorded as either dead or alive, as of 31 December 2011. Results 546 patients (333 males) were identified (median age at surgery 58.7 years; range 16.1–94.2). Data on mortality were available for all patients covering a median period of 8 years (range 1 month-48.5 years); 83 patients died (median age 77.8 years; range 36.4–98.3) (causes: cardio/cerebrovascular 33.7%, infections 30.1%, malignancies 28.9%, peri-operatively 1.2%, gastrointestinal haemorrhage 1.2%, suicide 1.2%, unknown 2.4%, old age 1.2%). SMR for total group:3.62 (95% CI:2.90–4.47; P!0.001), for those diagnosed before 1990:4.66 (95% CI:2.65– 7.63; P!0.001) and for those after 1990:3.53 (95% CI:2.77–4.44; P!0.001). Clinical follow-up data (until date of death or date the database was frozen) were available for 436 patients [269 males, median age at surgery 58.5 years; range 16.11–94.19), 203/431 with no or intrasellar remnant – 228/431 with extrasellar remnant after surgery, median follow-up 6.9 years (range 1 month-48.5 years), 111/436 with NFA regrowth, 188/436 received radiotherapy adjuvant or for regrowth]. Cox regression analysis (univariate followed by multivariate approach) demonstrated that amongst age at surgery, NFA regrowth, radiotherapy, sex, extent of removal, untreated GH deficiency, untreated FSH/LH deficiency, ACTH deficiency, TSH deficiency and treatment with DDAVP, only age remained an independent significant factor (HR 1.099, 95% CI: 1.073–1.126; P!0.001). Conclusions This is the first study assessing mortality in a large series of non-selected patients with NFA in the UK. Despite the improvement in the last three decades, mortality remains high. Apart from age, factors related with the management/outcome of the tumour are not independent predictors and pituitary hormone deficits managed with the currently used substitution protocols do not adversely affect mortality in this group of patients. DOI: 10.1530/endoabs.38.P310 P311 Endocrine Abstracts (2015) Vol 38