June 27, 2017
Patients with nonfunctioning pituitary adenoma who receive daily hydrocortisone replacement doses greater than 20 mg are at increased risk for death from any cause vs. similar patients receiving lower doses and those without secondary adrenal insufficiency, according to findings published in the European Journal of Endocrinology.
“The previously demonstrated excess mortality in patients with adrenal insufficiency has been mainly attributable to cardiovascular, respiratory and infectious diseases as well as cancer,” Daniel S. Olsson, MSc, MD, PhD, of the Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden, and colleagues wrote. “It is likely that the degree of adrenal insufficiency is of importance for outcome and that patients who are completely insufficient may be more vulnerable to intercurrent illness, whereas patients with partial [adrenocorticotropic hormone] deficiency may be overtreated under normal unstressed conditions using conventional replacement doses. Hence, inadequate treatment of hypocortisolism remains a significant cause of death during stressful events and intercurrent illness in patients with hypopituitarism.”