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Higher glucocortico...
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Hammarstrand, Casper,1990Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för invärtesmedicin och klinisk nutrition,Institute of Medicine, Department of Internal Medicine and Clinical Nutrition
(author)
Higher glucocorticoid replacement doses are associated with increased mortality in patients with pituitary adenoma
- Article/chapterEnglish2017
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LIBRIS-ID:oai:gup.ub.gu.se/259031
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https://gup.ub.gu.se/publication/259031URI
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https://doi.org/10.1530/EJE-17-0340DOI
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Subject category:art swepub-publicationtype
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OBJECTIVE: Patients with secondary adrenal insufficiency (AI) have an excess mortality. The objective was to investigate the impact of the daily glucocorticoid replacement dose on mortality in patients with hypopituitarism due to non-functioning pituitary adenoma (NFPA). METHODS: Patients with NFPA were followed between years 1997 and 2014 and cross-referenced with the National Swedish Death Register. Standardized mortality ratio (SMR) was calculated with the general population as reference and Cox-regression was used to analyse the mortality. RESULTS: The analysis included 392 patients (140 women) with NFPA. Mean±s.d. age at diagnosis was 58.7±14.6 years and mean follow-up was 12.7±7.2 years. AI was present in 193 patients, receiving a mean daily hydrocortisone equivalent (HCeq) dose of 20±6mg. SMR (95% confidence interval (CI)) for patients with AI was similar to that for patients without, 0.88 (0.68-1.12) and 0.87 (0.63-1.18) respectively. SMR was higher for patients with a daily HCeq dose of >20mg (1.42 (0.88-2.17)) than that in patients with a daily HCeq dose of 20mg (0.71 (0.49-0.99)), P=0.017. In a Cox-regression analysis, a daily HCeq dose of >20mg was independently associated with a higher mortality (HR: 1.88 (1.06-3.33)). Patients with daily HCeq doses of ≤20mg had a mortality risk comparable to patients without glucocorticoid replacement and to the general population. CONCLUSION: Patients with NFPA and AI receiving more than 20mg HCeq per day have an increased mortality. Our data also show that mortality in patients substituted with 20mg HCeq per day or less is not increased. © 2017 European Society of Endocrinology.
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Ragnarsson, Oskar,1971Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för invärtesmedicin och klinisk nutrition,Institute of Medicine, Department of Internal Medicine and Clinical Nutrition(Swepub:gu)xragos
(author)
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Hallén, T.
(author)
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Andersson, Eva,1955Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för samhällsmedicin och folkhälsa, enheten för arbets-och miljömedicin,Institute of Medicine, Department of Public Health and Community Medicine, Section of Occupational and environmental medicine(Swepub:gu)xaevae
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Skoglund, T.
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Nilsson, Anna G,1968Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för invärtesmedicin och klinisk nutrition,Institute of Medicine, Department of Internal Medicine and Clinical Nutrition(Swepub:gu)xnannx
(author)
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Johannsson, Gudmundur,1960Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för invärtesmedicin och klinisk nutrition,Institute of Medicine, Department of Internal Medicine and Clinical Nutrition(Swepub:gu)xjgudn
(author)
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Olsson, Daniel S,1983Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för invärtesmedicin och klinisk nutrition,Institute of Medicine, Department of Internal Medicine and Clinical Nutrition(Swepub:gu)xolssd
(author)
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Göteborgs universitetInstitutionen för medicin, avdelningen för invärtesmedicin och klinisk nutrition
(creator_code:org_t)
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In:European Journal of Endocrinology177:3, s. 251-2561479-683X
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