The incidence of cerebrovascular accidents and second brain tumors in patients with pituitary adenoma: A population-based study

Background. To assess the risk of cerebrovascular accidents (CVAs) and second brain tumors (SBTs) in patients with pituitary adenoma after surgery or radiotherapy. Methods. A cohort of 143 people from Olmsted County, who were diagnosed with pituitary adenoma between 1933 and 2000, was studied. Only patients from Olmsted County were included because of the unique nature of medical care in Olmsted County, which allows the ascertainment of virtually all cases of pituitary adenoma for this community's residents and comparisons to the general population in the county. Surgical resection was performed in 76 patients, 29 patients underwent radiotherapy (with 21 undergoing both surgery and radiotherapy), 5 patients were reirradiated, and 59 patients were managed conservatively and observed. Results. Median follow-up was 15.5 years. There was no difference in CVA-free survival between treatment groups. On univariate analysis age >60 years (hazard ratio [HR], 11.93; 95% CI, 6.26-23.03; P<.001); male sex (HR, 3.67; 95% CI, 2.03-6.84; P<.001), and reirradiation (HR, 3.41; 95% CI, 1.05-9.68; P =.04) were associated with worse CVA-free survival. In multivariate analysis, only age >60 years was associated with worse CVA-free survival. Compared with the general population, there was a 4-fold increase in the rate of CVAs in pituitary adenoma patients (HR, 4.2; 95% CI, 2.8-6.1). Two patients developed SBT (an irradiated patient and a surgically managed patient). Conclusion. CVA is a significant risk for patients with pituitary tumors, but treatment does not seem to impact the risk. Even with longterm follow-up, SBTs are a rare event regardless of treatment modality.