Excess mortality in patients with non-functioning pituitary adenoma: a systematic review and meta-analysis.

in Journal of endocrinological investigation by F Bioletto, M Sibilla, V Gasco, E Ghigo, S Grottoli

TLDR

  • Non-functioning pituitary adenoma (NFPA) is a rare condition that can cause a variety of symptoms and comorbidities. The study found that people with NFPA have a higher risk of dying compared to the general population. The study also found that age and sex can affect how much higher the risk of dying is. The study also found that the trend towards higher risk of dying is similar in people with normal or deficient pituitary function, especially in women and in people who were diagnosed at a younger age.

Abstract

Patients with non-functioning pituitary adenoma (NFPA) often present with a variety of clinical manifestations and comorbidities, mainly determined by the local mass effect of the tumor and by hypopituitarism. Whether this has an impact on overall mortality, however, is still unclear. PubMed/Medline, EMBASE, and Cochrane Library databases were systematically searched until May 2023 for studies reporting data either about standardized mortality ratios (SMRs) or about predictors of mortality in patients with NFPA. Effect sizes were pooled through a random-effect model. This systematic review and meta-analysis was registered in the International Prospective Register of Systematic Reviews (PROSPERO, #CRD42023417782). Eleven studies were eligible for inclusion in the systematic review; among these, five studies reported data on SMRs, with a total follow-up time of approximately 130,000 person-years. Patients with NFPA showed an increased mortality risk compared to the general population (SMR = 1.57 [95%CI: 1.20-1.99], p < 0.01). Age and sex appeared to act as effect modifiers, with a trend towards higher SMRs in females (SMR = 1.57 [95%CI: 0.91-2.41], p = 0.10) than in males (SMR = 1.00 [95%CI: 0.89-1.11], p = 0.97), and in patients diagnosed at age 40 years or younger (SMR = 3.19 [95%CI: 2.50-3.97], p < 0.01) compared to those with later onset of the disease (SMR = 1.26 [95%CI: 0.93-1.65], p = 0.13). The trend towards excess mortality was similar in patients with normal (SMR = 1.22 [95%CI: 0.94-1.53], p = 0.13) or deficient (SMR = 1.26 [95%CI: 0.82-1.79], p = 0.27) pituitary function. Excess mortality is observed in patients with NFPA, regardless of pituitary function, especially in women and in patients with a younger age at diagnosis.

Overview

  • The study aims to investigate the impact of non-functioning pituitary adenoma (NFPA) on overall mortality. The study uses a systematic review and meta-analysis of 11 studies that report data on standardized mortality ratios (SMRs) or predictors of mortality in patients with NFPA. The study finds that patients with NFPA have an increased mortality risk compared to the general population, with age and sex acting as effect modifiers. The trend towards excess mortality is similar in patients with normal or deficient pituitary function, especially in women and in patients with a younger age at diagnosis.

Comparative Analysis & Findings

  • The study finds that patients with NFPA have an increased mortality risk compared to the general population, with a standardized mortality ratio (SMR) of 1.57 (95%CI: 1.20-1.99). The study also finds that age and sex act as effect modifiers, with a trend towards higher SMRs in females and in patients diagnosed at age 40 years or younger. The trend towards excess mortality is similar in patients with normal or deficient pituitary function, especially in women and in patients with a younger age at diagnosis.

Implications and Future Directions

  • The study's findings suggest that NFPA is associated with an increased mortality risk, and that age and sex act as effect modifiers. The study's findings also suggest that the trend towards excess mortality is similar in patients with normal or deficient pituitary function, especially in women and in patients with a younger age at diagnosis. Future research should focus on identifying the underlying mechanisms of excess mortality in NFPA and on developing targeted interventions to improve outcomes in this population.
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