title: Determinants of clinical outcome and survival in acromegaly.
abstract: OBJECTIVE
  The extent to which treatment modifies the excess in morbidity and mortality in acromegaly remains uncertain. This study investigates the determinants of final outcome following therapy for acromegaly.
  
  
  METHODS
  A retrospective analysis of patients treated at the Departments of Endocrinology and Neurosurgery, Auckland Hospital, New Zealand.
  
  
  METHODS
  One hundred and fifty-one patients (63 females and 88 males) with acromegaly or gigantism treated between the years 1964 and 1989. The mean duration of follow-up was 12 years (median 11 years).
  
  
  METHODS
  Patients had their age, estimated duration of symptoms preceding diagnosis, serum GH at diagnosis, presence of diabetes mellitus, cardiovascular disease, hypertension and/or osteoarthritis at diagnosis and the last known serum GH documented. The final outcome at the time of study was graded under three classes: dead (n = 32), those with major complications (n = 47) and those with minor/no complications (n = 67).
  
  
  RESULTS
  The mean age at diagnosis of acromegaly was 41 years and the average estimated duration of symptoms prior to diagnosis was 7 years, with older patients showing longer duration of symptoms preceding diagnosis (P = 0.0002). Final outcome (dead, alive with major complications, alive and well) was significantly worse in those with older age at diagnosis (P = 0.008), longer duration of symptoms before diagnosis (P = 0.03) and higher GH at last follow-up (P = 0.0001). In multivariate analysis, survival was significantly influenced by the last known GH (P = 0.0001), presence of hypertension (P = 0.02) or cardiac disease (P = 0.03) at diagnosis, and duration of symptoms prior to diagnosis (P = 0.04). Survival in the acromegalic group, irrespective of treatment, was reduced by an average of 10 years compared with the non-acromegalic population.
  
  
  CONCLUSIONS
  Acromegaly has a significant adverse effect on well-being and survival. The predominant determinant of outcome is the final serum GH level following treatment.
authors.affiliation: Department of Endocrinology, Auckland Hospital, New Zealand.
authors.forename: C
authors.initials: C
authors.lastname: Rajasoorya
authors.forename: I M
authors.initials: IM
authors.lastname: Holdaway
authors.forename: P
authors.initials: P
authors.lastname: Wrightson
authors.forename: D J
authors.initials: DJ
authors.lastname: Scott
authors.forename: H K
authors.initials: HK
authors.lastname: Ibbertson
mesh_terms: D000172:Acromegaly / Q000097:blood / Q000150:complications / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery; D000328:Adult; D017668:Age of Onset; D002318:Cardiovascular Diseases / Q000150:complications; D048909:Diabetes Complications; D005260:Female; D013006:Growth Hormone / Q000097:blood*; D006801:Humans; D006973:Hypertension / Q000150:complications; D007016:Hypophysectomy; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000150:complications; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D013006:Growth Hormone