Joseph M Pappachan1, Diana Raskauskiene, V Raman Kutty, Richard N Clayton. 1. Department of Endocrinology (J.M.P., D.R.), Walsall Manor Hospital, West Midlands, WS2 9PS, United Kingdom; Achutha Menon Centre for Health Science Studies (V.R.K.), Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram, India 695011; and Keele University Medical School & University Hospital of North Staffordshire (R.N.C.), Stoke-on-Trent, Staffordshire ST4 6QG, United Kingdom.
Abstract
CONTEXT: Several previous observational studies showed an association between hypopituitarism and excess mortality. Reports on reduction of standard mortality ratio (SMR) with GH replacement have been published recently. OBJECTIVE: This meta-analysis assessed studies reporting SMR to clarify mortality risk in hypopituitary adults and also the potential benefit conferred by GH replacement. DATA SOURCES: A literature search was performed in Medline, Embase, and Cochrane library up to March 31, 2014. ELIGIBILITY CRITERIA: Studies with or without GH replacement reporting SMR with 95% confidence intervals (95% CI) were included. DATA EXTRACTION AND ANALYSIS: Patient characteristics, SMR data, and treatment outcomes were independently assessed by two authors, and with consensus from third author, studies were selected for analysis. Meta-analysis was performed in all studies together, and those without and with GH replacement separately, using the statistical package metafor in R. RESULTS: Six studies reporting a total of 19 153 hypopituiatary adults with a follow-up duration of more than 99,000 person years were analyzed. Hypopituitarism was associated with an overall excess mortality (weighted SMR, 1.99; 95% CI, 1.21-2.76) in adults. Female hypopituitary adults showed higher SMR compared with males (2.53 vs 1.71). Onset of hypopituitarism at a younger age was associated with higher SMR. GH replacement improved the mortality risk in hypopituitary adults that is comparable to the background population (SMR with GH replacement, 1.15; 95% CI, 1.05-1.24 vs SMR without GH, 2.40; 95% CI, 1.46-3.34). GH replacement conferred lower mortality benefit in hypopituitary women compared with men (SMR, 1.57; 95% CI, 1.38-1.77 vs 0.95; 95% CI, 0.85-1.06). LIMITATIONS: There was a potential selection bias of benefit of GH replacement from a post-marketing data necessitating further evidence from long-term randomized controlled trials. CONCLUSIONS: Hypopituitarism may increase premature mortality in adults. Mortality benefit from GH replacement in hypopituitarism is less pronounced in women than men.
CONTEXT: Several previous observational studies showed an association between hypopituitarism and excess mortality. Reports on reduction of standard mortality ratio (SMR) with GH replacement have been published recently. OBJECTIVE: This meta-analysis assessed studies reporting SMR to clarify mortality risk in hypopituitary adults and also the potential benefit conferred by GH replacement. DATA SOURCES: A literature search was performed in Medline, Embase, and Cochrane library up to March 31, 2014. ELIGIBILITY CRITERIA: Studies with or without GH replacement reporting SMR with 95% confidence intervals (95% CI) were included. DATA EXTRACTION AND ANALYSIS: Patient characteristics, SMR data, and treatment outcomes were independently assessed by two authors, and with consensus from third author, studies were selected for analysis. Meta-analysis was performed in all studies together, and those without and with GH replacement separately, using the statistical package metafor in R. RESULTS: Six studies reporting a total of 19 153 hypopituiatary adults with a follow-up duration of more than 99,000 person years were analyzed. Hypopituitarism was associated with an overall excess mortality (weighted SMR, 1.99; 95% CI, 1.21-2.76) in adults. Female hypopituitary adults showed higher SMR compared with males (2.53 vs 1.71). Onset of hypopituitarism at a younger age was associated with higher SMR. GH replacement improved the mortality risk in hypopituitary adults that is comparable to the background population (SMR with GH replacement, 1.15; 95% CI, 1.05-1.24 vs SMR without GH, 2.40; 95% CI, 1.46-3.34). GH replacement conferred lower mortality benefit in hypopituitary women compared with men (SMR, 1.57; 95% CI, 1.38-1.77 vs 0.95; 95% CI, 0.85-1.06). LIMITATIONS: There was a potential selection bias of benefit of GH replacement from a post-marketing data necessitating further evidence from long-term randomized controlled trials. CONCLUSIONS:Hypopituitarism may increase premature mortality in adults. Mortality benefit from GH replacement in hypopituitarism is less pronounced in women than men.
Authors: Sina Jasim; Fares Alahdab; Ahmed T Ahmed; Shrikant Tamhane; Larry J Prokop; Todd B Nippoldt; M Hassan Murad Journal: Endocrine Date: 2016-11-05 Impact factor: 3.633