title: Changes in the management and comorbidities of acromegaly over three decades: the French Acromegaly Registry.
abstract: BACKGROUND
  Acromegaly is a rare disease associated with chronic multisystem complications. National registries have been created in several countries.
  
  
  METHODS
  The French Registry contains data on acromegaly epidemiology, management and comorbidities recorded over more than three decades, retrospectively until 1999 and prospectively from 1999 to 2012.
  
  
  RESULTS
  Data could be analyzed for 999 of the 1034 patients included in the registry (46% males). Disease control, defined as IGF-I normalization (adjusted for age and sex), was achieved in 75% of patients at the last follow-up visit. Half the patients with uncontrolled disease had IGF-I levels below 1.5 times the upper limit of normal (ULN). The proportion of patients with surgically cured disease did not change markedly over time, whereas the proportion of patients with uncontrolled disease fell and the proportion of patients with medically controlled disease rose. Cardiovascular, metabolic, respiratory and rheumatologic comorbidities and their outcomes were recorded for most patients, and no noteworthy overall deterioration was noted over time. Cancer occurred in 10% of patients, for a standardized incidence ratio of 1.34 (95% CI: 0.94-1.87) in men and 1.24 (0.77-1.73) in women. Forty-one patients died during follow-up, for a standardized mortality ratio of 1.05 (0.70-1.42). Most deaths were due to cancer.
  
  
  CONCLUSIONS
  The majority of patients with acromegaly now have successful disease control thanks to the multistep management. The incidence of comorbidities following diagnosis of acromegaly is very low. Life expectancy is now close to that of the general population, probably owing to better management of the GH/IGF-I excess and comorbidities.
authors.affiliation: Assistance Publique-Hôpitaux de ParisHôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicêtre, France.|Univ Paris-SudFaculté de Médecine Paris-Sud, Unité Mixte de Recherche-S1185, Le Kremlin Bicêtre, France.|Institut National de la Santé et de la Recherche Médicale (INSERM) U1185Le Kremlin Bicêtre, France.
authors.forename: Luigi
authors.initials: L
authors.lastname: Maione
authors.affiliation: Université Aix-Marseille and Assistance Publique-Hôpitaux de MarseillePôle ENDO (Endocrinologie, Diabète, Obésité Nutrition), Hôpital de la Conception, Marseille, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Brue
authors.affiliation: Département de Médecine InterneService d'Endocrinologie, Centre Hospitalier Universitaire de Liège, Université de Liège, Domaine Universitaire du Sart-Tilman, Liège, Belgium.
authors.forename: Albert
authors.initials: A
authors.lastname: Beckers
authors.affiliation: Service d'EndocrinologieDiabète et Nutrition, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Reims, France.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Delemer
authors.affiliation: Département de Médecine InterneService d'Endocrinologie, Centre Hospitalier Universitaire de Liège, Université de Liège, Domaine Universitaire du Sart-Tilman, Liège, Belgium.
authors.forename: Patrick
authors.initials: P
authors.lastname: Petrossians
authors.affiliation: Université Lyon 1Lyon, France.|Hospices Civils de LyonFédération d'Endocrinologie du pôle Est, Lyon, France.|INSERM U1052UMR CNRS 5286, Centre de Recherche en Cancérologie de Lyon, Equipe Tumeurs Endocrines, Lyon, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Borson-Chazot
authors.affiliation: Service d'Endocrinologie-Diabétologie-NutritionPôle Digidune, Centre Hospitalier Universitaire de Grenoble and Université Grenoble Alpes, Grenoble, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Chabre
authors.affiliation: Service de NeurochirurgieCHRU de Tours; and Université François-Rabelais de Tours, Tours, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: François
authors.affiliation: Assistance Publique Hôpitaux de ParisService d'Endocrinologie, Hôpital Cochin, and Université Paris Descartes, Sorbonne Paris Cité, and INSERM U1016, CNRS UM8104, Institut Cochin, Paris, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Bertherat
authors.affiliation: Service de DiabétologieEndocrinologie et des Maladies Métaboliques, Hôpital Huriez, CHU de Lille, Lille, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Cortet-Rudelli
authors.affiliation: Assistance Publique-Hôpitaux de ParisHôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicêtre, France.|Univ Paris-SudFaculté de Médecine Paris-Sud, Unité Mixte de Recherche-S1185, Le Kremlin Bicêtre, France.|Institut National de la Santé et de la Recherche Médicale (INSERM) U1185Le Kremlin Bicêtre, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Chanson
mesh_terms: D000172:Acromegaly / Q000453:epidemiology* / Q000378:metabolism / Q000628:therapy*; D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000378:metabolism / Q000628:therapy; D015897:Comorbidity; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D012042:Registries; D012120:Respiration Disorders / Q000453:epidemiology / Q000378:metabolism / Q000628:therapy
chemical_list: D007334:Insulin-Like Growth Factor I