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Incidence of a Second Tumor in Hypopituitary Patients Operated for Pituitary Tumors¹

Department of Internal Medicine, Division of Diabetology and Endocrinology (E.M.E., B.B.), and Department of Occupational and Environmental Medicine (Z.M., L.H.), University Hospital, S-221 85 Lund, Sweden

Address all correspondence and requests for reprints to: Dr. Eva Marie Erfurth, Department of Internal Medicine, Division of Diabetology and Endocrinology, University Hospital, S-221 85 Lund, Sweden. E-mail: eva-marie.erfurth{at}med.lu.se

Recently, an association between increased blood levels of insulin-like growth factor I (IGF-I) and increased risks of prostate, breast, lung, and colorectal cancers has been suggested. As today adults with GH deficiency are subjected to GH substitution, there is a pressing need for baseline tumor incidence data. The aim of the study was to assess the risk for a second tumor in a cohort of 328 patients with hypopituitarism treated for a pituitary tumor from 1958–1992. The patients were receiving conventional hormone treatment, but without GH substitution. The overall tumor incidence [standardized incidence ratio (SIR)] was lower than expected (0.85), but the 95% confidence interval (CI) did not exclude unity (0.59–1.21). Only two prostate cancers occurred (SIR, 0.34; 95% CI, 0.04–1.24). Two brain tumors (SIR, 1.96; 95% CI, 0.24–7.08) and two endocrine tumors (part of multiple endocrine neoplasm syndromes; SIR, 4.00; 95% CI, 0.48–14.5) had occurred. When excluding brain and endocrine tumors, the overall SIR decreased to 0.77, but did still not differ significantly from unity (0.52–1.13). Thus, a tendency for a decreased overall tumor risk, although not statistically significant, was noted, especially when excluding brain and endocrine tumors. This tendency was more emphasized for prostate cancer, but low numbers hamper a firm conclusion. These results may serve as a baseline for tumor risk among adult patients with pituitary insufficiency supplemented with GH.

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