Low-dose glucocorticoid replacement therapy suggested for nonfunctioning pituitary adenomas
The importance of a balanced and adjusted glucocorticoid replacement therapy in patients with nonfunctioning pituitary adenomas has been reaffirmed by current data suggesting that a higher hydrocortisone dose is linked to increased mortality in patients with the disease.
Researchers from Switzerland conducted a retrospective study to determine whether high glucocorticoid replacement doses were associated with increased mortality in patients with nonfunctioning pituitary adenomas (NFPA) and hypothalamic-pituitary-adrenal (HPA) axis insufficiency. They examined 105 patients (mean age of 58.9 years) with 12.7 years of follow-up.
Patients were categorized into one of three groups: lowest weight-adapted hydrocortisone (HC; n=60), intermediate group (n=26), and highest HC dose (n=18). According to data, Kaplan-Meier survival probabilities varied greatly when compared with differing weight-adjusted HC dose (P=.001) and absolute HC dose (5-19 mg, 20-29 mg, and ≥30 mg; P=.009).
Similarly, HR for mortality increased from 1 (95% CI, 0.05-.24 mg/kg) to 2.62 (95% CI, 0.25-0.34 mg/kg) to 4.56 (95% CI, ≥0.35mg/kg, P for trend=.006) and from 1 (95% CI, 5-19 mg) to 2.03 (95% CI, 20-29 mg) to 4 (95% CI, ≥30 mg, P for trend=.029), for each group, researchers wrote.
“The present study provides evidence that a higher dose of HC replacement is associated with increased mortality in patients with NFPA and HPA insufficiency,” researchers wrote.
Thus, the researchers suggest lower doses of glucocorticoid replacement than those traditionally used for treatment of NFPA and HPA insufficiency
Disclosure: The researchers report no relevant financial disclosures.