Cardiovascular risk in patients with acromegaly vs. non-functioning pituitary adenoma following pituitary surgery: an active-comparator cohort study.

IF 3.3 2区医学 Q2 ENDOCRINOLOGY & METABOLISM Pituitary Pub Date : 2024-05-31 DOI:10.1007/s11102-024-01405-z

Melanie Stocker, Simona E Zimmermann, Rahel Laager, Claudia Gregoriano, Beat Mueller, Philipp Schuetz, Alexander Kutz

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Abstract

Purpose: Given the increased cardio-metabolic risk in patients with acromegaly, this study compared cardiovascular outcomes, mortality, and in-hospital outcomes between patients with acromegaly and non-functioning pituitary adenoma (NFPA) following pituitary surgery.

Methods: This was a nationwide cohort study using data from hospitalized patients with acromegaly or NFPA undergoing pituitary surgery in Switzerland between January 2012 and December 2021. Using 1:3 propensity score matching, eligible acromegaly patients were paired with NFPA patients who underwent pituitary surgery, respectively. The primary outcome comprised a composite of cardiovascular events (myocardial infarction, cardiac arrest, ischemic stroke, hospitalization for heart failure, unstable angina pectoris, cardiac arrhythmias, intracranial hemorrhage, hospitalization for hypertensive crisis) and all-cause mortality. Secondary outcomes included individual components of the primary outcome, surgical re-operation, and various hospital-associated outcomes.

Results: Among 231 propensity score-matched patients with acromegaly and 491 with NFPA, the incidence rate of the primary outcome was 8.18 versus 12.73 per 1,000 person-years (hazard ratio [HR], 0.64; [95% confidence interval [CI], 0.31-1.32]). Mortality rates were numerically lower in acromegaly patients (2.43 vs. 7.05 deaths per 1,000 person-years; HR, 0.34; [95% CI, 0.10-1.17]). Individual components of the primary outcome and in-hospital outcomes showed no significant differences between the groups.

Conclusion: This cohort study did not find an increased risk of cardiovascular outcomes and mortality in patients with acromegaly undergoing pituitary surgery compared to surgically treated NFPA patients. These findings suggest that there is no legacy effect regarding higher cardio-metabolic risk in individuals with acromegaly once they receive surgical treatment.

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垂体手术后肢端肥大症患者与无功能垂体腺瘤患者的心血管风险：主动比较队列研究。

目的：鉴于肢端肥大症患者的心血管代谢风险增加，本研究对接受垂体手术的肢端肥大症和无功能垂体腺瘤（NFPA）患者的心血管预后、死亡率和住院预后进行了比较：这是一项全国性队列研究，使用的数据来自2012年1月至2021年12月期间在瑞士接受垂体手术的肢端肥大症或NFPA住院患者。采用1:3倾向得分匹配法，将符合条件的肢端肥大症患者与接受垂体手术的NFPA患者分别配对。主要结果包括心血管事件（心肌梗死、心脏骤停、缺血性中风、心力衰竭住院、不稳定型心绞痛、心律失常、颅内出血、高血压危象住院）和全因死亡率的复合结果。次要结果包括主要结果的各个组成部分、再次手术和各种医院相关结果：在 231 名倾向评分匹配的肢端肥大症患者和 491 名 NFPA 患者中，主要结果的发生率为每千人年 8.18 例与 12.73 例（危险比 [HR]，0.64；[95% 置信区间 [CI]，0.31-1.32]）。肢端肥大症患者的死亡率在数字上更低（每千人年2.43例与7.05例相比；HR，0.34；[95% CI，0.10-1.17]）。主要结果和住院结果的各个组成部分在两组间无显著差异：这项队列研究并未发现接受垂体手术治疗的肢端肥大症患者与接受手术治疗的NFPA患者相比，心血管结局和死亡率风险增加。这些研究结果表明，肢端肥大症患者一旦接受手术治疗，其心血管代谢风险就会升高，但并不存在遗留效应。

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来源期刊

Pituitary 医学-内分泌学与代谢

CiteScore

7.10

自引率

7.90%

发文量

审稿时长

6 months

期刊介绍： Pituitary is an international publication devoted to basic and clinical aspects of the pituitary gland. It is designed to publish original, high quality research in both basic and pituitary function as well as clinical pituitary disease. The journal considers: Biology of Pituitary Tumors Mechanisms of Pituitary Hormone Secretion Regulation of Pituitary Function Prospective Clinical Studies of Pituitary Disease Critical Basic and Clinical Reviews Pituitary is directed at basic investigators, physiologists, clinical adult and pediatric endocrinologists, neurosurgeons and reproductive endocrinologists interested in the broad field of the pituitary and its disorders. The Editorial Board has been drawn from international experts in basic and clinical endocrinology. The journal offers a rapid turnaround time for review of manuscripts, and the high standard of the journal is maintained by a selective peer-review process which aims to publish only the highest quality manuscripts. Pituitary will foster the publication of creative scholarship as it pertains to the pituitary and will provide a forum for basic scientists and clinicians to publish their high quality pituitary-related work.