Endocrine Abstracts

Acromegaly is a rare disorder characterized by the overproduction of growth hormone (GH) and elevated insulin-like growth factor-1 (IGF1). While some studies have investigated the potential associations between biochemical control (i.e., normalization of IGF-1 and/or GH) and comorbidities/symptoms, few studies have long-term follow-up. This study assessed the association between biochemical control and selected comorbidities/symptoms in patients with acromegaly using real world longitudinal data. Medical records of adult patients with a confirmed acromegaly diagnosis, ≥2 valid readings of GH and IGF1, and ≥6 months of follow-up at an endocrinology center in Naples, Italy, were reviewed. For this analysis, patients were followed from the first medical encounter with a GH/IGF1 measurement at the center until the occurrence of comorbidities/symptoms (i.e., event), loss to follow-up, or death (i.e., censoring). Biochemical control was assessed annually and defined as having >50% days with IGF1 measurements ≤ the upper limit of normal, or GH measurements ≥2.5 μg/l when IGF1 was not available. Comorbidities/symptoms assessed included arthropathy, cancer, cardiovascular system disorders (CVsD) and component conditions, cerebrovascular disease, colon polyps, endocrine and metabolic system disorders and component conditions, and sleep apnea. Time-varying Cox models, adjusting for age and sex, were used to assess the association between biochemical control and comorbidities/symptoms. Hazard ratios (HRs) and confidence intervals (CIs) were estimated. Of the 150 eligible patients, all were Caucasian, 47% were female, on average 43.1 years old (range: 19–70) at diagnosis, with a mean follow-up time of 8 years (range: 0–31). The mean GH level during the follow-up was 8.3±11.9 μg/l and 367.7±154.2 μg/ml for IGF1. The three most commonly observed incident comorbidities/symptoms during follow-up were endocrine and metabolic system disorders (94.3%), CVsD (63.4%), and arthropathy (48.5%). Biochemical control was significantly associated with a lower hazard of CVsD (HR=0.54, 95% CI=0.31–0.93). While significance was not reached for endocrine and metabolic system disorders as a whole (HR=1.01, 95% CI=0.78–1.33), biochemical control was significantly associated with a lower hazard of diabetes (HR=0.36, 95% CI=0.15–0.83). Biochemical control was significantly associated with a higher hazard of certain types of arthropathy (HR=1.68, 95% CI=1.04–2.71), but not with the remaining comorbidities/symptoms assessed. These results highlight the importance of achieving biochemical control, since this may reduce the risk of costly conditions, including CVsD and diabetes. The association found for arthropathy may suggest the irreversibility of this acromegaly-related impairment.