ECE2016 Eposter Presentations Pituitary - Clinical (83 abstracts)
1Department of Clinical and Experimental Medicine, Endocrinology Section, University of Pisa, Pisa, Italy; 2Epidemiology and Biostatistics Unit, Institute of Clinical Physiology, National Research Council (C.N.R.), Pisa, Italy; 3Department of Pathology, University of Pisa, Pisa, Italy.
Context: Acromegalic patients have a high-risk cardiovascular profile. However, the determinants of cardiovascular risk factors and major cardiovascular events (MACE), which may develop after diagnosis of acromegaly, are not fully understood.
Objectives: To identify the predictors for systemic comorbidities and MACE, after diagnosis of disease. The role of therapy for acromegaly on the occurrence of such complications was also evaluated.
Patients and methods: Retrospective cohort study on 200 consecutive acromegalic patients. The following outcomes were evaluated: diabetes mellitus, arterial hypertension, hypercholesterolemia and MACE. Each patient was included in the analysis for a specific outcome if it was not present at diagnosis of acromegaly and further classified as: 1) in remission after adenomectomy (Hx), 2) controlled by somatostatin analogues (SSA) (SSAc) or 3) not controlled by SSA (SSAnc). Data were evaluated using Cox regression analysis.
Results: After diagnosis of acromegaly, diabetes occurred in 40.8% of the patients (Hx 27.3%; SSAc 40%; SSAnc 65%; P=0.002); lack of control of acromegaly was decisive for the onset of the outcome (HR=3.32; P=0.006). Hypertension arose in 35.5% of the patients (Hx 33.3%; SSAc 36.8%; SSAnc 50%; P=0.0172). The strongest determinants of this outcome were age at diagnosis of acromegaly (HR=1.059; P=0.014) and body mass index (HR=1.05; P=0.014). Hypercholesterolemia occurred in 47.8% of the patients without differences among the 3 groups (P=0.322). Disease activity was a predictor of hypercholesterolemia (HR=2.14; P=0.004). MACE were recorded in 12.7% of the patients (Hx 15%; SSAc 10.9%; SSAnc 13.6%; P=0.247). Age at diagnosis of acromegaly (HR=1.09; P=0.005) and smoking habit (HR=5.95; P=0.001) were associated with an increased risk of MACE.
Conclusion: After diagnosis of acromegaly, control of disease (irrespectively to the type of treatment) and lifestyle are predictors of the occurrence of cardiovascular risk factors and cardiovascular events.