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Risk Factors for Cerebrovascular Deaths in Patients Operated and Irradiated for Pituitary Tumors

Departments of Internal Medicine, Division of Diabetology and Endocrinology (E.M.E., B.B., K.O.), Occupational and Environmental Medicine (Z.M., J.B., L.H.), Neurology (B.N.), and Radiation Physics (G.S.-T.), 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.

Abstract

Vascular mortality, especially cerebrovascular disease (CVD), are the most pronounced cause of mortality in women with hypopituitarism. In a cohort of 342 patients operated and irradiated for pituitary tumors, 31 died from CVD (CVD patients) between 1952 and 1996. The study assessed whether the radiation regimens and duration of symptoms of hypopituitarism before operation differed between the 31 CVD patients and the 62 matched patients from the same cohort who had not died from CVD (control patients). Furthermore, the infarction/hemorrhage ratio, type of clinical stroke syndrome, and time to death after stroke were investigated in the CVD patients and in matched controls from the general population who had died from CVD (population controls).

No significant differences in maximum or centrally absorbed dose, maximum or central biological equivalent dose, field size, or number of fraction were recorded between CVD and control patients. A significant difference in the duration of symptoms of hypopituitarism before operation was recorded, but only in women (P = 0.01). There were no significant differences in the infarction/hemorrhage ratio (P > 0.3) of lacunar or posterior circulation syndrome compared with middle cerebral artery syndrome with cortical features (P = 0.22) or the proportion of patients who died within the first month after stroke onset (60% vs. 59%, respectively) between CVD patients and population controls.

In conclusion, no significant effect on CVD deaths could be detected for any radiation parameter. A long history of unsubstituted pituitary insufficiency may be a contributing factor to the very high CVD mortality among women. There were no indications of significant differences in type of stroke, clinical stroke syndromes, or stroke fatality between the CVD patients and the population controls.

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