title: Predictors of morbidity and mortality in acromegaly: an Italian survey.
abstract: OBJECTIVE
  To describe demographic and hormonal characteristics, comorbidities (diabetes mellitus and hypertension), therapeutic procedures and their effectiveness, as well as predictors of morbidity and mortality in a nationwide survey of Italian acromegalic patients.
  
  
  METHODS
  Retrospective multicenter epidemiological study endorsed by the Italian Society of Endocrinology and performed in 24 tertiary referral Italian centers. The mean follow-up time was 120 months.
  
  
  RESULTS
  A total of 1512 patients, 41% male, mean age: 45±13 years, mean GH: 31±37 μg/l, IGF1: 744±318 ng/ml, were included. Diabetes mellitus was reported in 16% of cases and hypertension in 33%. Older age and higher IGF1 levels at diagnosis were significant predictors of diabetes and hypertension. At the last follow-up, 65% of patients had a controlled disease, of whom 55% were off medical therapy. Observed deaths were 61, with a standardized mortality ratio of 1.13 95% (confidence interval (CI): 0.87-1.46). Mortality was significantly higher in the patients with persistently active disease (1.93; 95% CI: 1.34-2.70). Main causes of death were vascular diseases and malignancies with similar prevalence. A multivariate analysis showed that older age, higher GH at the last follow-up, higher IGF1 levels at diagnosis, malignancy, and radiotherapy were independent predictors of mortality.
  
  
  CONCLUSIONS
  Pretreatment IGF1 levels are important predictors of morbidity and mortality in acromegaly. The full hormonal control of the disease, nowadays reached in the majority of patients with modern management, reduces greatly the disease-related mortality.
authors.affiliation: Department of Clinical Sciences and Community Health, University of Milan, Unit of Endocrine Diseases and Diabetology, S. Giuseppe Hospital Multimedica, Via S Vittore, 12, 20123 Milan, Italy. maura.arosio@unimi.it
authors.forename: M
authors.initials: M
authors.lastname: Arosio
authors.forename: G
authors.initials: G
authors.lastname: Reimondo
authors.forename: E
authors.initials: E
authors.lastname: Malchiodi
authors.forename: P
authors.initials: P
authors.lastname: Berchialla
authors.forename: A
authors.initials: A
authors.lastname: Borraccino
authors.forename: L
authors.initials: L
authors.lastname: De Marinis
authors.forename: R
authors.initials: R
authors.lastname: Pivonello
authors.forename: S
authors.initials: S
authors.lastname: Grottoli
authors.forename: M
authors.initials: M
authors.lastname: Losa
authors.forename: S
authors.initials: S
authors.lastname: Cannavò
authors.forename: F
authors.initials: F
authors.lastname: Minuto
authors.forename: M
authors.initials: M
authors.lastname: Montini
authors.forename: M
authors.initials: M
authors.lastname: Bondanelli
authors.forename: E
authors.initials: E
authors.lastname: De Menis
authors.forename: C
authors.initials: C
authors.lastname: Martini
authors.forename: G
authors.initials: G
authors.lastname: Angeletti
authors.forename: A
authors.initials: A
authors.lastname: Velardo
authors.forename: A
authors.initials: A
authors.lastname: Peri
authors.forename: M
authors.initials: M
authors.lastname: Faustini-Fustini
authors.forename: P
authors.initials: P
authors.lastname: Tita
authors.forename: F
authors.initials: F
authors.lastname: Pigliaru
authors.forename: G
authors.initials: G
authors.lastname: Borretta
authors.forename: C
authors.initials: C
authors.lastname: Scaroni
authors.forename: N
authors.initials: N
authors.lastname: Bazzoni
authors.forename: A
authors.initials: A
authors.lastname: Bianchi
authors.forename: M
authors.initials: M
authors.lastname: Appetecchia
authors.forename: F
authors.initials: F
authors.lastname: Cavagnini
authors.forename: G
authors.initials: G
authors.lastname: Lombardi
authors.forename: E
authors.initials: E
authors.lastname: Ghigo
authors.forename: P
authors.initials: P
authors.lastname: Beck-Peccoz
authors.forename: A
authors.initials: A
authors.lastname: Colao
authors.forename: M
authors.initials: M
authors.lastname: Terzolo
mesh_terms: D000172:Acromegaly / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality*; D000328:Adult; D003625:Data Collection; D005260:Female; D005500:Follow-Up Studies; D019382:Human Growth Hormone / Q000032:analysis / Q000097:blood; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I