ECE2018 Oral Communications The curious case of growth hormone (5 abstracts)
Postoperative use of somatostatin analogs and mortality in patients with acromegaly
Mark R Postma 1 , Thalijn LC Wolters 2 , Gerrit van den Berg 1 , Antonius E van Herwaarden 3 , Anneke C Muller Kobold 4 , Wim J Sluiter 1 , Margreet A Wagenmakers 2, , Alfons CM van den Bergh 6 , Bruce HR Wolffenbuttel 1 , Ad RMM Hermus 2 , Romana T Netea-Maier 2 & André P van Beek 1
1Department of Endocrinology, University Medical Center Groningen, Groningen, Netherlands; 2Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, Netherlands; 3Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Netherlands; 4Department of Laboratory Medicine, University Medical Center Groningen, Groningen, Netherlands; 5Department of Internal Medicine, Centre for Lysosomal and Metabolic Diseases, Erasmus MC, Rotterdam, Netherlands; 6Department of Radiation Oncology, University Medical Center Groningen, Groningen, Netherlands.
Objective: To assess the effect of somatostatin analogs (SSTA) on mortality in relation to metabolic control of acromegaly after pituitary surgery.
Design: A retrospective study in two large tertiary referral centers in The Netherlands.
Patients and methods: Three hundred and nineteen patients with acromegaly in whom pituitary surgery was performed as primary therapy between January 1980 and July 2017 were included (total follow-up: 3887 patient years). Postoperative treatment with SSTA was prescribed to 174 (55%) patients because of persistent or recurrent disease. Metabolic control at last visit was assessed by local IGF1 standard deviation score (SDS). Adequate metabolic control was defined as an IGF-1 SDS ≤ 2. Univariate determinants of mortality and standardized mortality ratios (SMR) were calculated for groups with and without SSTA at any moment postoperatively and at last visit.
Results: In total, 27 deaths were observed. SSTA use was not associated with increased mortality. In univariate analysis, determinants of mortality were inadequate metabolic control (RR 3.41, P=0.005), surgery by craniotomy/combined approach (RR 3.53, P=0.013) and glucocorticoid substitution (RR 2.11, P=0.047). The SMR of patients with adequate metabolic control who used SSTA at any moment postoperatively (1.06, P=0.959) and at last visit (1.19; P=0.769) was not increased. Insufficiently controlled patients had a significantly raised SMR (3.94, P<0.001).
Conclusion: Postoperative use of SSTA is not associated with increased mortality in patients with acromegaly when adequately controlled. In contrast, inadequate metabolic control, primary surgery by craniotomy/combined approach, and glucocorticoid substitution are associated with increased mortality.
Volume 56
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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