A positive effect of GH treatment on CVD and fracture risk could be concluded , but study design limitations have to be considered .
Stroke and secondary brain tumours remained more prevalent .
Regrowth and recurrences of (peri)pituitary tumours were not increased in patients with GH treatment compared to similar patients without GH treatment .
All fatal and nonfatal malignancies were not more prevalent in  GH-treated adults compared to the general population .
Due to the positive effects demonstrated in r and omized clinical trials on cardiovascular surrogate markers and bone metabolism , a positive effect of growth hormone ( GH ) treatment on clinical ly relevant end-points seems feasible .
In this review , we discuss the long-term efficacy and safety of GH treatment in adult patients with growth hormone deficiency ( GHD ) with emphasis on morbidity : fatal and nonfatal cardiovascular disease ( CVD ) and stroke , fractures , fatal and nonfatal malignancies and recurrences , and diabetes mellitus .
Deaths among adult patients with hypopituitarism: hypocortisolism during acute stress, and de novo malignant brain tumors contribute to an increased mortality.
CONTEXT Patients with hypopituitarism have an increased st and ardized mortality rate . The basis for this has not been fully clarified . OBJECTIVE To investigate in detail the cause of death in a large cohort of patients with hypopituitarism subjected to long-term follow-up . DESIGN AND METHODS All-cause and cause-specific mortality in 1286 Swedish patients with hypopituitarism prospect ively monitored in KIMS ( Pfizer International Metabolic Data base ) 1995 - 2009 were compared to general population data in the Swedish National Cause of Death Registry . In addition , events reported in KIMS , medical records , and postmortem reports were review ed . MAIN OUTCOME MEASURES St and ardized mortality ratios ( SMR ) were calculated , with stratification for gender , attained age , and calendar year during follow-up . RESULTS An excess mortality was found , 120 deaths vs 84.3 expected , SMR 1.42 ( 95 % confidence interval : 1.18 - 1.70 ) . Infections , brain cancer , and sudden death were associated with significantly increased SMRs ( 6.32 , 9.40 , and 4.10 , respectively ) . Fifteen patients , all ACTH-deficient , died from infections . Eight of these patients were considered to be in a state of adrenal crisis in connection with death ( medical reports and post-mortem examinations ) . Another 8 patients died from de novo malignant brain tumors , 6 of which had had a benign pituitary lesion at baseline . Six of these 8 subjects had received prior radiation therapy . CONCLUSION Two important causes of excess mortality were identified : first , adrenal crisis in response to acute stress and intercurrent illness ; second , increased risk of a late appearance of de novo malignant brain tumors in patients who previously received radiotherapy . Both of these causes may be in part preventable by changes in the management of pituitary disease
A positive effect of GH treatment on CVD and fracture risk could be concluded , but study design limitations have to be considered .
Stroke and secondary brain tumours remained more prevalent .
Regrowth and recurrences of (peri)pituitary tumours were not increased in patients with GH treatment compared to similar patients without GH treatment .
All fatal and nonfatal malignancies were not more prevalent in  GH-treated adults compared to the general population .
Due to the positive effects demonstrated in r and omized clinical trials on cardiovascular surrogate markers and bone metabolism , a positive effect of growth hormone ( GH ) treatment on clinical ly relevant end-points seems feasible .
In this review , we discuss the long-term efficacy and safety of GH treatment in adult patients with growth hormone deficiency ( GHD ) with emphasis on morbidity : fatal and nonfatal cardiovascular disease ( CVD ) and stroke , fractures , fatal and nonfatal malignancies and recurrences , and diabetes mellitus .