title: Mortality in acromegaly: a 20-year follow-up study.
abstract: It is unclear whether mortality still is increased in acromegaly and whether there are gender-related differences. We dynamically assessed outcome during long-term follow-up in our nationwide cohort.
  
  
  
  We studied standardized mortality ratios (SMRs) relative to the general population and causes of death in acromegaly (n=333) compared with age- and gender-matched controls (n=4995).
  
  
  
  During 20 (0-33) years follow-up, 113 (34%) patients (n=333, 52% women) and 1334 (27%) controls (n=4995) died (P=0.004). SMR (1.9, 95% CI: 1.53-2.34, P<0.001) and all-cause mortality (OR 1.6, 95% CI: 1.2-2.2, P<0.001) were increased in acromegaly. Overall distribution of causes of death (P<0.001) differed between patients and controls but not cardiovascular (34% vs 33%) or cancer deaths (27% vs 27%). In acromegaly, but not in controls, causes of deaths shifted from 44% cardiovascular and 28% cancer deaths during the first decade, to 23% cardiovascular and 35% cancer deaths during the next two decades. In acromegaly, cancer deaths were mostly attributed to pancreatic adenocarcinoma (n=5), breast (n=4), lung (n=3) and colon (n=3) carcinoma. In acromegaly, men were younger than women at diagnosis (median 44.5 vs 50 years, P<0.001) and death (67 vs 76 years, P=0.0015). Compared with controls, women (36% vs 25%, P<0.01), but not men (31% vs 28%, P=0.44), had increased mortality.
  
  
  
  In acromegaly, men are younger at diagnosis and death than women. Compared with controls, mortality is increased during 20 years of follow-up, especially in women. Causes of deaths shift from predominantly cardiovascular to cancer deaths.
authors.affiliation: Division of EndocrinologyAbdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Elina
authors.initials: E
authors.lastname: Ritvonen
authors.affiliation: Department of BiostatisticsUniversity of Turku, Turku, Finland.
authors.forename: Eliisa
authors.initials: E
authors.lastname: Löyttyniemi
authors.affiliation: School of MedicineUniversity of Tampere, Tampere, Finland Department of Internal MedicineTampere University Hospital, Tampere, Finland Department of Internal MedicineSeinäjoki Central Hospital, Seinäjoki, Finland.
authors.forename: Pia
authors.initials: P
authors.lastname: Jaatinen
authors.affiliation: University of OuluOulu, Finland Oulu University HospitalOulu, Finland.
authors.forename: Tapani
authors.initials: T
authors.lastname: Ebeling
authors.affiliation: University of Eastern FinlandKuopio, Finland Kuopio University HospitalKuopio, Finland.
authors.forename: Leena
authors.initials: L
authors.lastname: Moilanen
authors.affiliation: Turku PET centreUniversity of Turku, Turku, Finland Department of EndocrinologyTurku University Hospital, Turku, Finland.
authors.forename: Pirjo
authors.initials: P
authors.lastname: Nuutila
authors.affiliation: Center of Internal Medicine and RehabilitationJorvi Hospital, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Ritva
authors.initials: R
authors.lastname: Kauppinen-Mäkelin
authors.affiliation: Division of EndocrinologyAbdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland camilla.schalin-jantti@hus.fi.
authors.forename: Camilla
authors.initials: C
authors.lastname: Schalin-Jäntti
mesh_terms: D000172:Acromegaly / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult
keywords: acromegaly; functioning pituitary adenoma; mortality