Bates A S, Van't Hoff W, Jones P J, Clayton R N
Department of Medicine, School of Post Graduate Medicine, Hartshill, Stoke-on-Trent, United Kingdom.
J Clin Endocrinol Metab. 1996 Mar;81(3):1169-72. doi: 10.1210/jcem.81.3.8772595.
One hundred and seventy-two patients with partial or complete hypopituitarism diagnosed between 1967 and 1994 were studied retrospectively. Those with acromegaly or Cushing's disease were excluded. One hundred and two patients were male (median age at, diagnosis, 53 yr; range, 12-78 yr) and 70 female (median age at diagnosis, 51 yr; range, 1-74 yr). In 131 patients the cause of hypopituitarism was a pituitary tumor or the effects of its treatment, as the majority underwent surgery and/or radiotherapy. In 22, the cause was an extrapituitary tumor, 14 were termed idiopathic, 2 developed hypopituitarism as a result of basal sarcoid, 2 were due to trauma, and 1 was the result of Sheehan's syndrome. The patients were treated with standard replacement therapy. Mortality due to all causes was higher than expected in an age- and sex-matched control population (ratio of observed/expected deaths, 1.73; 95% confidence interval, 1.28-2.28; P < 0.01). Females tended to have a worse prognosis (ratio of observed/expected deaths, 2.29; 95% confidence interval, 1.37-3.58; P < 0.01) than their male counterparts (ratio of observed/expected deaths, 1.50; 95% confidence interval, 1.02-2.13; P < 0.01). There was a small but nonsignificant increase in the number of deaths due to vascular disease (ratio of observed/expected deaths, 1.35; 95% confidence interval, 0.84-2.07; P = 0.11). The only significant independent predictive factors for survival were age at diagnosis and hypogonadism. The majority of the male hypogonadal cohort received replacement therapy (79%), but fewer of the females did so (27%). Hypogonadal patients had a better prognosis than their eugonadal counterparts (log rank, 6.85; P < 0.01). Our data confirmed that mortality in patients with hypopituitarism is significantly increased. However, the contribution of vascular disease to this poor prognosis was not as great as previously reported, and overall, our results favor a multifactorial explanation of the poor long term outcome.
对1967年至1994年间诊断为部分或完全性垂体功能减退的172例患者进行了回顾性研究。排除肢端肥大症或库欣病患者。102例为男性（诊断时中位年龄53岁；范围12 - 78岁），70例为女性（诊断时中位年龄51岁；范围1 - 74岁）。131例患者垂体功能减退的病因是垂体肿瘤或其治疗的影响，因为大多数患者接受了手术和/或放疗。22例病因是垂体外肿瘤，14例为特发性，2例因基底结节病导致垂体功能减退，2例因外伤，1例因席汉综合征。患者接受标准替代治疗。所有原因导致的死亡率高于年龄和性别匹配的对照人群预期（观察到的/预期死亡人数之比为1.73；95%置信区间为1.28 - 2.28；P < 0.01）。女性预后往往比男性差（观察到的/预期死亡人数之比为2.29；95%置信区间为1.37 - 3.58；P < 0.01），而男性为（观察到的/预期死亡人数之比为1.50；95%置信区间为1.02 - 2.13；P < 0.01）。血管疾病导致的死亡人数有小幅但不显著的增加（观察到的/预期死亡人数之比为1.35；95%置信区间为0.84 - 2.07；P = 0.11）。生存的唯一显著独立预测因素是诊断时的年龄和性腺功能减退。大多数性腺功能减退的男性队列接受了替代治疗（79%），但接受治疗的女性较少（27%）。性腺功能减退患者的预后优于性腺功能正常的患者（对数秩检验，6.85；P < 0.01）。我们的数据证实垂体功能减退患者的死亡率显著增加。然而，血管疾病对这种不良预后的影响不如先前报道的那么大，总体而言，我们的结果支持对长期不良结局进行多因素解释。
