Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland.
Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.
Pituitary. 2024 Oct;27(5):518-526. doi: 10.1007/s11102-024-01405-z. Epub 2024 May 31.
Given the increased cardio-metabolic risk in patients with acromegaly, this study compared cardiovascular outcomes, mortality, and in-hospital outcomes between patients with acromegaly and non-functioning pituitary adenoma (NFPA) following pituitary surgery.
This was a nationwide cohort study using data from hospitalized patients with acromegaly or NFPA undergoing pituitary surgery in Switzerland between January 2012 and December 2021. Using 1:3 propensity score matching, eligible acromegaly patients were paired with NFPA patients who underwent pituitary surgery, respectively. The primary outcome comprised a composite of cardiovascular events (myocardial infarction, cardiac arrest, ischemic stroke, hospitalization for heart failure, unstable angina pectoris, cardiac arrhythmias, intracranial hemorrhage, hospitalization for hypertensive crisis) and all-cause mortality. Secondary outcomes included individual components of the primary outcome, surgical re-operation, and various hospital-associated outcomes.
Among 231 propensity score-matched patients with acromegaly and 491 with NFPA, the incidence rate of the primary outcome was 8.18 versus 12.73 per 1,000 person-years (hazard ratio [HR], 0.64; [95% confidence interval [CI], 0.31-1.32]). Mortality rates were numerically lower in acromegaly patients (2.43 vs. 7.05 deaths per 1,000 person-years; HR, 0.34; [95% CI, 0.10-1.17]). Individual components of the primary outcome and in-hospital outcomes showed no significant differences between the groups.
This cohort study did not find an increased risk of cardiovascular outcomes and mortality in patients with acromegaly undergoing pituitary surgery compared to surgically treated NFPA patients. These findings suggest that there is no legacy effect regarding higher cardio-metabolic risk in individuals with acromegaly once they receive surgical treatment.
鉴于肢端肥大症患者心血管代谢风险增加，本研究比较了肢端肥大症患者与接受垂体手术的无功能垂体腺瘤（NFPA）患者的心血管结局、死亡率和住院结局。
这是一项全国性队列研究，使用了 2012 年 1 月至 2021 年 12 月期间在瑞士接受垂体手术的肢端肥大症或 NFPA 住院患者的数据。通过 1:3 倾向评分匹配，将肢端肥大症患者与接受垂体手术的 NFPA 患者进行配对。主要结局包括心血管事件（心肌梗死、心脏骤停、缺血性中风、心力衰竭住院、不稳定型心绞痛、心律失常、颅内出血、高血压危象住院）和全因死亡率的复合结局。次要结局包括主要结局的各个组成部分、再次手术和各种与医院相关的结局。
在 231 名匹配的肢端肥大症患者和 491 名 NFPA 患者中，主要结局的发生率分别为 8.18 与 12.73 例/1000 人年（风险比[HR]，0.64；95%置信区间[CI]，0.31-1.32）。肢端肥大症患者的死亡率略低（2.43 与 7.05 例/1000 人年死亡；HR，0.34；95%CI，0.10-1.17）。主要结局的各个组成部分和住院结局在两组之间无显著差异。
与接受手术治疗的 NFPA 患者相比，接受垂体手术的肢端肥大症患者的心血管结局和死亡率没有增加的风险。这些发现表明，一旦肢端肥大症患者接受手术治疗，他们的心血管代谢风险就不会增加。
