Predictors of Overall Mortality in Pituitary Adenomas.

Abstract

Purpose: Various predictors of overall mortality like hypopituitarism and treatment have been demonstrated in pituitary adenomas. Whether these predictors are specific to tumor subtype was not studied. We aimed to directly compare predictors of mortality in clinically significant pituitary adenoma subtypes (acromegaly, Cushing's disease, macroprolactinomas and non-functioning pituitary macroadenomas).

Methods: We retrospectively analyzed all patients with acromegaly (n=224), Cushing's disease (n=42), macroprolactinoma (n=123) and non-functioning pituitary macroadenomas (n=310) admitted in our department between 2011 and 2025. The following variables were retrieved: sex, age and maximum tumor diameter at diagnosis, hypopituitarism and radiotherapy.

Results: Age and tumor size at diagnosis and rates of hypopituitarism and radiotherapy varied considerably between 38 and 57 years (macroprolactinomas vs. non-functioning pituitary macroadenomas), 7 and 25 mm (Cushing's disease vs. macroprolactinomas), 25 and 47% (acromegaly vs. non-functioning pituitary macroadenomas) and 6 and 38% (macroprolactinomas vs Cushing's disease), respectively. Univariate analysis showed that age at diagnosis was positively associated with mortality in all pituitary adenoma subtypes while hypopituitarism was both negatively (hazard ratio=0.37, acromegaly) and positively (hazard ratio=2.71, non-functioning pituitary macroadenomas) correlated with mortality. In multivariate analysis, age at diagnosis remained a consistent predictor (hazard ratio between 1.07 and 1.11) of overall mortality across the entire cohort. Cushing's disease was significantly associated with mortality while hypopituitarism predicted mortality only in non-functioning pituitary macroadenomas (hazard ratio=2.71). Sex, tumor size at diagnosis and radiotherapy were not associated with mortality.

Conclusion: We confirmed that age is the main predictor of mortality in pituitary adenomas with a similar hazard ratio across all subtypes. Hypopituitarism was associated with an increased mortality only in those with non-functioning macroadenomas.