A nationwide survey of mortality in acromegaly.
BACKGROUND
Increased mortality in acromegaly has been confined to those with posttreatment basal GH of 2.5 microg/liter or greater, but the impact of IGF-I and pituitary radiotherapy on mortality has remained controversial.


OBJECTIVE
The purpose of this nationwide survey was to examine the all-cause mortality of patients with acromegaly and evaluate the impact of treatment outcome and mode of treatment on survival.


METHODS
All-cause mortality of all patients with acromegaly diagnosed during January 1980 and December 1999 in the five university hospitals of Finland was followed up by the end of 2002 (12.5 +/- 5.6 yr) and compared with that of the general population by using age- and gender-adjusted standardized mortality ratios (SMRs). Logistic regression analysis was used to investigate factors related to mortality within the survey population.


METHODS
Mortality was the main outcome measure.


RESULTS
Of the 334 patients, 56 (16.8%) had died during follow-up. SMR of the patients was 1.16 [confidence interval (CI) 0.85-1.54, not significant (NS)]. However, patients with basal serum GH concentration 2.5 microg/liter or greater (SMR 1.63, CI 1.10-2.35, P < 0.001) measured 5.2 +/- 4.4 yr after the initial treatment, and those irradiated (SMR 1.69, CI 1.05-2.58, P < 0.001) showed excess mortality. In a multivariate model, the effect of radiotherapy was of borderline significance only (P = 0.083). Posttreatment IGF-I levels, available for 72.2% of the patients, did not have impact on mortality.


CONCLUSIONS
The posttreatment basal GH concentration less than 2.5 microg/liter in acromegalic patients is associated with a normal lifespan. Excess mortality is confined to poorly controlled patients and possibly those who have received conventional radiotherapy.
Kauppinen-Mäkelin
Ritva
R
Department of Internal Medicine, Jorvi Hospital, FIN-02740 Espoo, Finland. ritva.kauppinen-makelin@hus.fi
Sane
Timo
T
Reunanen
Antti
A
Välimäki
Matti J
MJ
Niskanen
Leo
L
Markkanen
Helene
H
Löyttyniemi
Eliisa
E
Ebeling
Tapani
T
Jaatinen
Pia
P
Laine
Hanna
H
Nuutila
Pirjo
P
Salmela
Pasi
P
Salmi
Jorma
J
Stenman
Ulf-Håkan
UH
Viikari
Jorma
J
Voutilainen
Erkki
E
D000172:Acromegaly / Q000401:mortality* / Q000532:radiotherapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D002423:Cause of Death; D005260:Female; D005387:Finland / Q000453:epidemiology; D019382:Human Growth Hormone / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016896:Treatment Outcome
D019382:Human Growth Hormone