{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T21:52:32Z","timestamp":1786571552551,"version":"build-2736575974"},"reference-count":31,"publisher":"The Endocrine Society","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,4,1]]},"abstract":"<jats:sec>\n                    <jats:title>Context:<\/jats:title>\n                    <jats:p>Several previous observational studies showed an association between hypopituitarism and excess mortality. Reports on reduction of standard mortality ratio (SMR) with GH replacement have been published recently.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>This meta-analysis assessed studies reporting SMR to clarify mortality risk in hypopituitary adults and also the potential benefit conferred by GH replacement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources:<\/jats:title>\n                    <jats:p>A literature search was performed in Medline, Embase, and Cochrane library up to March 31, 2014.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Eligibility Criteria:<\/jats:title>\n                    <jats:p>Studies with or without GH replacement reporting SMR with 95% confidence intervals (95% CI) were included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Extraction and Analysis:<\/jats:title>\n                    <jats:p>Patient characteristics, SMR data, and treatment outcomes were independently assessed by two authors, and with consensus from third author, studies were selected for analysis. Meta-analysis was performed in all studies together, and those without and with GH replacement separately, using the statistical package metafor in R.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Six studies reporting a total of 19 153 hypopituiatary adults with a follow-up duration of more than 99 000 person years were analyzed. Hypopituitarism was associated with an overall excess mortality (weighted SMR, 1.99; 95% CI, 1.21\u20132.76) in adults. Female hypopituitary adults showed higher SMR compared with males (2.53 vs 1.71). Onset of hypopituitarism at a younger age was associated with higher SMR. GH replacement improved the mortality risk in hypopituitary adults that is comparable to the background population (SMR with GH replacement, 1.15; 95% CI, 1.05\u20131.24 vs SMR without GH, 2.40; 95% CI, 1.46\u20133.34). GH replacement conferred lower mortality benefit in hypopituitary women compared with men (SMR, 1.57; 95% CI, 1.38\u20131.77 vs 0.95; 95% CI, 0.85\u20131.06).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Limitations:<\/jats:title>\n                    <jats:p>There was a potential selection bias of benefit of GH replacement from a post-marketing data necessitating further evidence from long-term randomized controlled trials.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Hypopituitarism may increase premature mortality in adults. Mortality benefit from GH replacement in hypopituitarism is less pronounced in women than men.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1210\/jc.2014-3787","type":"journal-article","created":{"date-parts":[[2015,2,6]],"date-time":"2015-02-06T12:18:45Z","timestamp":1423225125000},"page":"1405-1411","source":"Crossref","is-referenced-by-count":131,"title":["Excess Mortality Associated With Hypopituitarism in Adults: A Meta-Analysis of Observational Studies"],"prefix":"10.1210","volume":"100","author":[{"given":"Joseph M.","family":"Pappachan","sequence":"first","affiliation":[{"name":"Department of Endocrinology (J.M.P., D.R.), Walsall Manor Hospital, West Midlands, WS2 9PS, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Raskauskiene","sequence":"additional","affiliation":[{"name":"Department of Endocrinology (J.M.P., D.R.), Walsall Manor Hospital, West Midlands, WS2 9PS, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V. 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