Factors influencing mortality in acromegaly

Area of Science:

• Endocrinology
• Oncology
• Clinical Medicine

Background:

• Acromegaly is associated with a doubled mortality rate compared to the general population.
• Effective treatment modalities necessitate identifying prognostic factors for mortality.
• Previous studies highlight the increased mortality risk in acromegaly patients.

Purpose of the Study:

• To identify prognostic factors for mortality in acromegaly patients.
• To evaluate the impact of treatment on mortality in acromegaly.
• To determine the relationship between growth hormone (GH) and insulin-like growth factor I (IGF-I) levels and survival.

Main Methods:

• A cohort of 208 acromegalic patients treated between 1964 and 2000 were followed for a mean of 13 years.
• Data collected included age at diagnosis, presence of hypertension and diabetes, hypopituitarism, and last follow-up GH and IGF-I levels.
• Multivariate analysis was used to identify independent predictors of survival.

Main Results:

• Seventy-two patients died during the study period. Older age at diagnosis, hypertension, diabetes, and hypopituitarism were associated with higher mortality.
• Observed to expected (O/E) mortality ratios decreased significantly with lower last follow-up GH levels (P < 0.001) and normalized IGF-I levels.
• Last serum GH, age, duration of symptoms, and hypertension were independent predictors of survival. IGF-I SD score was also a significant predictor.

Conclusions:

• Reduction of GH to less than 1 microg/liter or normalization of serum IGF-I is associated with reduced mortality in acromegaly patients.
• GH and IGF-I are equivalent predictors of mortality in acromegaly.
• Effective management of acromegaly should focus on achieving biochemical control to improve survival rates.