Excess Mortality Among Hospitalized Patients With Hypopituitarism - A Population-Based, Matched-Cohort Study

Context: Patients with hypopituitarism face excess mortality in the long-term outpatient setting. However, associations of pituitary dysfunction with outcomes in acutely hospitalized patients are lacking. Objective: The objective of this work is to assess clinical outcomes of hospitalized patients with hypopituitarism with or without diabetes insipidus (DI). Design, Setting, and Patients: In this population-based, matched-cohort study from 2012 to 2017, hospitalized adult patients with a history of hypopituitarism were 1:1 propensity score-matched with a general medical inpatient cohort. Main Outcome Measures: The primary outcome was in-hospital mortality. Secondary outcomes included all-cause readmission rates within 30 days and 1 year, intensive care unit (ICU) admission rates, and length of hospital stay. Results: After matching, 6764 cases were included in the study. In total, 3382 patients had hypopituitarism and of those 807 (24%) suffered from DI. All-cause in-hospital mortality occurred in 198 (5.9%) of patients with hypopituitarism and in 164 (4.9%) of matched controls (odds ratio [OR] 1.32, [95% CI, 1.06-1.651, P= .013). Increased mortality was primarily observed in patients with DI (OR 3.69 [95% CI, 2.44-5.58], P< .001). Patients with hypopituitarism had higher ICU admissions (OR 1.50 [95% Cl, 1.30474 P< and faced a 2.4-day prolonged length of hospitalization (95% CI, 1.94-2.95, P< .001) compared to matched controls. Risk of 30-day (OR 1.31 [95% CI, 1.13-1.51], P< .001) and 1-year readmission (OR 1.29 [95% CI, 1.17-1.42], P< .001) was higher among patients with hypopituitarism as compared with medical controls. Conclusions: Patients with hypopituitarism are highly vulnerable once hospitalized for acute medical conditions with increased risk of mortality and adverse clinical outcomes. This was most pronounced among those with DI.