Excess mortality in acromegaly.
BACKGROUND
Increased production of growth hormone (GH) and insulin-like growth factor-I (IGF-I) in patients with acromegaly is associated with a twofold increase in mortality compared with the general population. The range of standardised mortality rates in various studies ranges from 1.2 to 3.6.
Multivariate analysis has indicated that post-treatment serum GH levels and, in a number of studies, serum IGF-I levels are the most powerful predictors of outcome. Normal IGF-I concentrations and random GH levels <2.5 microg/l measured by polyclonal radioimmunoassay result in optimal outcome. Other factors adversely influencing mortality include hypertension and a long interval between onset of the disorder and diagnosis.


CONCLUSIONS
Analysis of recent reports suggests that adoption of treatment guidelines with appropriate post-treatment target ranges for GH and IGF-I, together with the availability of newer methods to control GH oversecretion, has significantly improved patient outcomes.
Holdaway
I M
IM
Department of Endocrinology, Greenlane Clinical Centre, Auckland City Hospital, Auckland, New Zealand. ian@adhb.govt.nz
D000172:Acromegaly / Q000097:blood / Q000150:complications / Q000401:mortality* / Q000532:radiotherapy; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality; D002423:Cause of Death; D019382:Human Growth Hormone / Q000097:blood; D006801:Humans; D006973:Hypertension / Q000150:complications; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D011237:Predictive Value of Tests; D011832:Radiation Injuries / Q000150:complications; D012307:Risk Factors; D013997:Time Factors
D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I