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An audit of outcome of treatment in acromegaly
A S Bates1, W Van't Hoff, J M Jones
1Department of Diabetes and Endocrinology, North Staffordshire Royal Infirmary, Hartshill, Stoke-on-Trent, Staffordshire.
Insights
Acromegaly continues to be linked with higher mortality rates. However, normalizing growth hormone levels significantly improves survival, suggesting a key therapeutic target for this condition.
Area of Science:
- Endocrinology
- Clinical Medicine
- Epidemiology
Background:
- Acromegaly, a disorder caused by excess growth hormone, has historically been associated with increased mortality.
- The impact of modern treatments on acromegaly-related mortality requires ongoing investigation.
Purpose of the Study:
- To determine if acromegaly is still associated with increased mortality.
- To assess the influence of growth hormone levels, diabetes, and hypertension on long-term outcomes.
- To evaluate the effectiveness of achieving specific growth hormone level targets on patient survival.
Main Methods:
- A retrospective hospital case note review of 79 acromegaly patients followed since 1967.
- Life table analysis was used to compare observed mortality to the general population.
- Growth hormone secretion was assessed and compared between deceased and living patients.
Main Results:
- Acromegaly remains associated with increased mortality (observed/expected deaths ratio = 2.68).
- Patients with growth hormone levels below 5 mU/l exhibited survival rates comparable to the general population.
- Higher pre-treatment growth hormone levels were observed in deceased patients; diabetes and hypertension did not significantly influence mortality.
- Vascular causes accounted for 57% of deaths.
Conclusions:
- Growth hormone hypersecretion is a significant contributor to excess mortality in acromegaly.
- Therapeutic goals should focus on reducing average daytime growth hormone levels to below 5 mU/l.
- Further large-scale studies are needed to compare treatment modalities' effects on growth hormone secretion and long-term outcomes.
Abstract:
In order to determine whether acromegaly is still associated with increased mortality, a hospital case note review of all patients with acromegaly followed up in Stoke-on-Trent since 1967 was carried out. Of 79 subjects identified, 51 are alive and being monitored and 28 have died. Mortality was compared to the general population by life table analysis. Secretion of growth hormone was assessed and compared in dead and alive patients. The effect of diabetes, hypertension, and growth hormone secretion on long-term outcome was assessed. Acromegaly is still associated with increased mortality, with an overall ratio of observed to expected deaths equal to 2.68 (95% C.I. 1.8-3.9; p < 0.001), but the survival of 31 (39%) patients whose growth hormone level had been reduced to below 5 mU/l was equal to that of the general population (O/E = 1.42; 95% C.I. 0.46-3.31: p > 0.05). The dead patients had had significantly higher growth hormone levels than those still alive, but mortality did not appear to be influenced by diabetes or hypertension. The cause of death was vascular in 57% of cases. Growth hormone hypersecretion is still associated with excess mortality in acromegaly. The present study suggests that the therapeutic objective should be to lower average daytime growth hormone levels to less than 5 mU/l. There is need for a large study to compare different modes of treatment in terms of their effect on growth hormone secretion and on long-term outcome.