Endocrine Abstracts

Introduction: Acromegaly is associated with an increased mortality in untreated patients. Recent papers suggest an improvement of survival in the last years.

Aims: To assess mortality ratio and to identify prognostic factors associated with mortality in acromegaly in the last decade.

Methods: 297 patients (186 F/111 M, mean age 49.8±0.7 years) with acromegaly admitted in a single Neuroendocrinology Department between Jan 2001 and Dec 2010 were retrospectively studied. Serum GH levels were measured by IRMA (sensitivity 0.1 ng/ml). PAMCOMP computation program was used to calculate standardized mortality ratio (SMR). Cox regression analysis revealed independent factors associated with mortality.

Results: During follow-up (median 5.9 years −1689.85 person years), 21 patients died (7.07%), corresponding to a death rate of 12.5 deaths/1000 person years. All causes mortality was not statistically different from that of general population: SMR was 0.94 (95% confidence interval (CI) 0.58–1.45). Those dying (mean death age 62.7±2.8 years) were significantly older at diagnosis (age at diagnosis 50.3±2.6 years in dying patients vs 43.7±0.7 years in survivors, P=0.02) and had higher posttreatment serum GH levels (16.4±4.1 ng/ml in dying vs 8.1±0.9 ng/ml in surviving patients, P=0.04). Survivors were more likely to be treated by pituitary surgery (160/274 patients), and/or somatostatin analogues (79/274 patients) than dying patients (7/21 received operation, P=0.02 and 2/21 received somatostatin analogues, P=0.04); radiotherapy did not seem to influence overall mortality. When assessed by Cox-regression analysis, last serum GH levels (hazard ratio (HR) 1.06, 95% CI 1.03–1.09), acromegaly duration (HR 1.08, 95% CI 1.02–1.1) and age at diagnosis (HR 1.06, 95% CI 1.02–1.1) were independent predictors of mortality. Patients with posttreatment GH levels above 5.5 ng/ml had an increased SMR: 1.7 (95% CI 1.003–2.853).

Conclusions: Patients with acromegaly admitted in the last decade had a mortality rate close to the expected level, mainly due to modern therapy. Posttreatment serum GH levels and acromegaly duration were the main predictors of survival.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.