• Thomas Zueger, Paul Kirchner, Coline Herren, Stefan Fischli, Marcel Zwahlen, Emanuel Christ, and Christoph Stettler.
• Division of Endocrinology, Diabetes, and Clinical Nutrition, Inselspital, Bern University Hospital, and Institute of Social and Preventive Medicine, University of Bern, CH-3010 Bern, Switzerland.
• J. Clin. Endocrinol. Metab. 2012 Oct 1; 97 (10): E1938-42.

ContextCurrent 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).ObjectiveOur 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 InterventionWe 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.SettingThis was a retrospective analysis conducted at a tertiary referral center.Main OutcomeWe evaluated overall mortality based on HC replacement doses.ResultsAverage 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.ConclusionHigher 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.

29 keywords...

hide…