title: Successful mortality reduction and control of comorbidities in patients with acromegaly followed at a highly specialized multidisciplinary clinic.
abstract: BACKGROUND
  Acromegaly is usually due to the excessive secretion of GH by a pituitary adenoma. It is frequently accompanied by comorbidities that compromise quality of life and results in elevated mortality rates.
  
  
  OBJECTIVE
  To evaluate mortality and morbidity in patients with acromegaly receiving multimodal care.
  
  
  METHODS
  Tertiary care center.
  
  
  METHODS
  Retrospective evaluation of 442 patients (65.4% women; mean age, 43.5 ± 13.1 y) followed for a median of 6 years (interquartile range [IQR], 3-10).
  
  
  RESULTS
  Twenty-two patients died during the study period (4.9%), representing a total standardized mortality ratio (SMR) of 0.72 (95% confidence interval [CI], 0.41-1.03). Standardized mortality ratios were 1.5 and 0.44 for patients whose last GH was above and below 2.5 ng/mL, respectively; 1.17 and 0.16 for those whose last GH was above and below 1 ng/mL, respectively; and 0.94 and 0.46 for those whose last IGF-1 was above and below 1.2 times the upper limit of normal (ULN), respectively. The prevalence of diabetes mellitus, hypertension, heart disease, and cancer was 30%, 35%, 8%, and 4.7%, respectively. The most common cause of death was cancer. On multivariate analysis, diabetes, heart disease, and cancer were related to a baseline GH > 10 ng/mL; the presence of cancer and the last IGF-1 were significant predictors of mortality. Survival decreased as the latest GH levels increased from < 1 ng/mL to > 5 ng/mL and as IGF-1 increased from < 1.2 to > 2 times the ULN.
  
  
  CONCLUSIONS
  Mortality in acromegaly can be successfully reduced, provided patients are treated using a multimodal approach with careful management of comorbidities.
authors.affiliation: Endocrinology Service/Experimental Endocrinology Unit (M.M., B.G., G.V., C.R., A.L.E.d.l.M., E.S., P.J., P.R., V.M.) and Department of Neurosurgery (B.L.-F., G.G.), Hospital de Especialidades, Centro Medico Nacional S.XXI, Instituto Mexicano del Seguro Social, Mexico City 11560, Mexico; and Neurological Center (M.M., B.G., C.R., G.G.), ABC Medical Center, Mexico City 05300, Mexico.
authors.forename: Moises
authors.initials: M
authors.lastname: Mercado
authors.forename: Baldomero
authors.initials: B
authors.lastname: Gonzalez
authors.forename: Guadalupe
authors.initials: G
authors.lastname: Vargas
authors.forename: Claudia
authors.initials: C
authors.lastname: Ramirez
authors.forename: Ana Laura Espinosa
authors.initials: AL
authors.lastname: de los Monteros
authors.forename: Ernesto
authors.initials: E
authors.lastname: Sosa
authors.forename: Paola
authors.initials: P
authors.lastname: Jervis
authors.forename: Paola
authors.initials: P
authors.lastname: Roldan
authors.forename: Victoria
authors.initials: V
authors.lastname: Mendoza
authors.forename: Blas
authors.initials: B
authors.lastname: López-Félix
authors.forename: Gerardo
authors.initials: G
authors.lastname: Guinto
mesh_terms: D000172:Acromegaly / Q000150:complications / Q000401:mortality / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003131:Combined Modality Therapy; D015897:Comorbidity; D005260:Female; D019382:Human Growth Hormone / Q000097:blood; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I