| Excess mortality for patients with residual disease following resection of pituitary adenomas. | |
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MedLine Citation:
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PMID: 21476061 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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The importance of achieving tumor control in pituitary adenoma surgery is not entirely established. This manuscript reviews the literature linking residual pituitary tumor and hormonal hypersecretion to increases in long term mortality. When possible, we utilized meta-analysis methods to estimate a pooled standardized mortality ratio (SMR), which relates the risk of mortality for a cohort of patients compared to a similar age and gender matched cohort in the general population, for patients with endocrinologic evidence of residual disease. When this was not possible, we review the existing literature in the results and discussion section of this review. We identified 10 articles regarding acromegaly and three articles regarding Cushing's disease which presented SMR data for adult patients undergoing transphenoidal surgery with data divided into subgroups based on post-operative growth hormone levels. Using growth hormone levels of 2.5 μg/l as a cutoff, the mortality rate ratio was 1.83 (95% CI = 1.03-3.24) for patients with persistent acromegaly. Similarly, patients with persistent Cushing's disease experienced a marked increase in mortality rate ratio compared to those experiencing initial cure (mortality rate ratio = 3.25 (95% CI = 1.54-6.84). For other tumor subtypes, (i.e. Endocrine inactive adenomas, Prolactinomas, and TSH secreting tumors) there were not enough studies identified to allow for rigorous statistical analysis. There is an increasing body of data suggesting that treatment refractory acromegaly and Cushing's disease puts patients at risk for early mortality, suggesting that aggressive efforts to normalize hormone levels in these patients are justified. |
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Authors:
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Michael E Sughrue; Edward F Chang; Rodney A Gabriel; Manish K Aghi; Lewis S Blevins |
Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-4-8 |
Journal Detail:
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Title: Pituitary Volume: - ISSN: 1573-7403 ISO Abbreviation: - Publication Date: 2011 Apr |
Date Detail:
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Created Date: 2011-4-8 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9814578 Medline TA: Pituitary Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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California Center for Pituitary Disorders, University of California, 400 Parnassus Avenue, Room A-808, San Francisco, CA, 94143-0350, USA, Sughruem@neurosurg.ucsf.edu. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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