Growth Hormone and Pituitary Radiotherapy, But Not Serum Insulin-Like Growth Factor-I Concentrations, Predict Excess Mortality in Patients with Acromegaly
TLDR
It is suggested that reduction of GH levels to less than 2 micro g/liter is beneficial in terms of improving long-term outcome and the sole use of IGF-I as a marker for effective treatment of acromegaly is not justified by this data.Abstract:
Increased mortality in patients with acromegaly has been confirmed in a number of retrospective studies, but causative factors and relationship to serum IGF-I remain uncertain. The West Midlands Pituitary database contains details of 419 patients (241 female) with acromegaly. Serum IGF-I data from the Regional Endocrine Laboratory were available for 360 patients (86%). At diagnosis, mean age was 47 yr (range, 12-84) and mean duration of follow-up was 13 yr (0.5-48). Sixty-one percent were treated by surgery and 39% by nonsurgical means. Radiotherapy was used alone or as adjuvant therapy in 50%. All patients were registered with the Office of National Statistics to obtain information on deaths. At the date of analysis (31 December 2001), 95 of the 419 patients had died (43 males), giving a standardized mortality ratio of 1.26 [confidence interval (CI), 1.03-1.54; P = 0.046]. After controlling for age and sex, data indicated that mortality was increased in subjects with posttreatment GH levels more than 2 micro g/liter, compared with those with levels less than 2 micro g/liter [ratio of mortality rates (RR), 1.55 (range, 0.97-2.50); P = 0.068]. By contrast, a much smaller increase was observed for subjects with elevated posttreatment IGF-I levels compared with those with normal levels [RR, 1.20 (range, 0.71-2.03); P = 0.50]. Treatment with radiotherapy was associated with increased mortality [RR, 1.67 (range, 1.09-2.56); P = 0.018], with cerebrovascular disease the predominant cause of death [standardized mortality ratio, 4.42 (range, 2.71-7.22); P = 0.005]. These results confirm the increased mortality in acromegaly and suggest that reduction of GH levels to less than 2 micro g/liter is beneficial in terms of improving long-term outcome. The sole use of IGF-I as a marker for effective treatment of acromegaly is not justified by this data. This study also highlights the potential deleterious effect of radiotherapy.read more
Citations
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A Consensus on Criteria for Cure of Acromegaly
Andrea Giustina,Philippe Chanson,Marcello D. Bronstein,Anne Klibanski,Steven W. J. Lamberts,Felipe F. Casanueva,Peter J Trainer,Ezio Ghigo,Ken K. Y. Ho,Shlomo Melmed +9 more
TL;DR: Criteria to define active acromegaly and disease control were agreed, and several significant changes were made to the 2000 guidelines.
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Guidelines for Acromegaly Management: An Update
Shlomo Melmed,Annamaria Colao,Ariel L. Barkan,Mark E. Molitch,Ashley B. Grossman,David L. Kleinberg,David R. Clemmons,Philippe Chanson,Edward R. Laws,Janet A. Schlechte,Mary Lee Vance,Ken K. Y. Ho,Andrea Giustina +12 more
TL;DR: The group developed a consensus on the approach to managing acromegaly including appropriate roles for neurosurgery, medical therapy, and radiation therapy in the management of these patients.
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Mortality and Cancer Incidence in Acromegaly: A Retrospective Cohort Study
TL;DR: Mortality rates due to colon cancer, all malignant disease, cardiovascular disease and overall mortality were increased with higher posttreatment GH leve...