Despite control of excess hormone secretion and a high tumor control rate, the effect of individual treatments on survival of patients with pituitary adenoma is not clear. Poor control of acromegaly has been associated with increased mortality from cardiovascular disease, with a suggestion of reduced mortality when GH levels return to normal (34-36). Large cohort studies of patients with pituitary adenoma, including both secreting and nonfunctioning tumors, have reported excess mortality (37-42), predominantly owing to cardiovascular and cerebrovascular causes. A cohort of patients with pituitary adenoma treated at the Royal Marsden Hospital followed during a 30-yr period had a relative risk of death of1.58 (95% confidence interval [CI]: 1.32-1.90) compared to an age- and sex-matched normal population. There was excess mortality from pituitary tumors and consequent endocrine disorders, from second brain tumors (43), and from cerebrovascular deaths. Mortality from cerebrovascular disorders accounted for 25% of deaths, with an estimated relative risk of death from cerebrovascular causes of 4.11 (95% CI: 2.84-5.75) compared with the normal population (61). Hypopituitarism has been postulated to contribute to the increased mortality. However, the influence of individual treatment modalities and the specific contribution of radiation to long-term survival remain poorly defined.

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