Endocrine Abstracts

Aim: Acromegaly is associated with higher mortality and morbidity, and achieving disease control can be challenging. The aim of this study was to assess the morbidity and mortality associated with active acromegaly compared to patients in whom disease control was achieved.

Methods: Retrospective analysis of all patients treated with acromegaly at a university hospital between 1948 and 2014 was performed. Mortality rates and development of new cardiovascular morbidity (CVE) (diabetes, hypertension, strokes, myocardial infarction or cardiac failure) were assessed. Number of various treatment modalities including medical therapy (somatostatin analogues, dopamine agonist, pegvisomant) was assessed. All GH values were converted to mcg/l; IgF-1 was not included due to limited availability of data.

Results: Of the 167 patients included, 116 achieved disease control with treatment. Comparing patients achieving control of acromegaly vs patients who did not achieve control, baseline parameters at diagnosis were (p value not significant unless specified): age 47.5 vs 53.9, (P<0.005), GH 16.6 vs 28.6 (P<0.05), proportion with pituitary axes failure 9.5% vs 16%, proportion with macroadenomas 78.5% vs 82%, P<0.0001, CVE 33.6% vs 36%. Total period of follow up was 163 vs 102 months (P<0.05). During follow up: number of treatment modalities used 2.25 vs 1.8, proportion of patients with new pituitary axes failure 38.8% vs 32%, number of failed axes 1.8 vs 1.5 and new CVE 33.6% vs 36%. Duration to develop CVE was 144 vs 69 months (P<0.05). Mortality rates were lower in cohort who achieved disease control (30.2% vs 64%, P<0.0001).

Conclusion: The group failing to achieve acromegaly disease control had higher GH at diagnosis, had macroadenomas and were older. Despite aggressive treatment approach in this group, disease control was challenging. Increased GH exposure contributes to earlier development of CVE and higher mortality rates and therefore it is important to offer such patients additional treatments.