Predictors of overall mortality in pituitary adenomas

Purpose: Various predictors of overall mortality like hypopituitarism or treatment have been demonstrated in pituitary adenomas (PA). Whether these predictors are specific to tumor subtype was not studied. We aimed to directly compare predictors of mortality in clinically significant PA subtypes (acromegaly, Cushing’s disease (CD), macroprolactinomas (MacroPRM) and non-functioning pituitary macroadenomas (MacroNFPA). Methods: We retrospectively analyzed all patients with acromegaly (n=224), CD (n=42), MacroPRM (n=123) and MacroNFPA (n=310) admitted in our department between 2011 and 2025. The following variables were retrieved: sex, age and maximum tumor diameter at diagnosis, hypopituitarism and radiotherapy. Results: Age and tumor size at diagnosis and rates of hypopituitarism or radiotherapy varied considerably between 38 and 57 years (MacroPRM vs. MacroNFPA), 7 and 25 mm (CD vs. MacroPRM), 25 and 47% (acromegaly vs. MaroNFPA) and 6 and 38% (MacroPRM vs CD) respectively. Univariate analysis showed age at diagnosis being positively associated with mortality in all PA subtypes while hypopituitarism was both negatively (HR=0.37, acromegaly) and positively (HR=2.71, MacroNFPA) correlated with mortality. In multivariate analysis age at diagnosis remained a consistent predictor (hazard ratio between 1.07 and 1.11) of overall mortality across the entire cohort. Cushing’s disease was significantly associated with mortality while hypopituitarism predicted mortality only in MacroNFPA (HR=2.71). Sex, tumor size at diagnosis and radiotherapy were not associated with mortality. Conclusion: we confirmed that age is the main predictor of mortality in pituitary adenomas with a similar hazard ratio across all subtypes. Hypopituitarism was associated with an increased mortality only in those with non-functioning macroadenomas.