Acromegaly: An epidemiological study

Etxabe, Julen; Gaztambide, Sonia; Latorre, Pilar; Vázquez, J. Arco

doi:10.1007/bf03344942

Cited by 151 publications

(104 citation statements)

References 30 publications

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“…In accordance with our results of the Bulgarian cohort, increased vascular mortality has been reported in several studies (20,21,22,23,24). On the other hand, a tendency toward increased life expectancy has been observed in recent studies (22,23,24,25,26,27,28,29,30,31,32,33,34).…”

Section: Discussionsupporting

confidence: 92%

Could different treatment approaches in acromegaly influence life expectancy? A comparative study between Bulgaria and Campania (Italy)

Colao

Vandeva

Pivonello

et al. 2014

European Journal of Endocrinology

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Background: Mortality in acromegaly strictly depends on optimal control of GH and IGF1 levels. Modern medical therapy with somatostatin analogs (SSAs) and GH receptor antagonists (GHRAs) is not available in many countries due to funding restrictions. This retrospective, comparative, cohort study investigated the impact of different treatment modalities on disease control (GH and IGF1) and mortality in acromegaly patients. Methods: Two cohorts of patients with acromegaly from Bulgaria (nZ407) and Campania, Italy (nZ220), were compared, and mortality rates were evaluated during a 10-year period (1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008). Results: The major difference in treatment approach between cohorts was the higher utilization of SSAs and GHRAs in Italy, leading to a decreased requirement for radiotherapy. Significantly more Italian than Bulgarian patients had achieved disease control (50.1 vs 39.1%, PZ0.005) at the last follow-up. Compared with the general population, the Bulgarian cohort had a decreased life expectancy with a standardized mortality ratio (SMR) of 2.0 (95% CI 1.54-2.47) that was restored to normal in patients with disease control -SMR 1.25 (95% CI 0.68-1.81). Irradiated patients had a higher cerebrovascular mortality -SMR 7.15 (95% CI 2.92-11.37). Internal analysis revealed an independent role of age at diagnosis and last GH value on all-cause mortality and radiotherapy on cerebrovascular mortality. Normal survival rates were observed in the Italian cohort: SMR 0.66 (95% CI 0.27-1.36). Conclusions: Suboptimal biochemical control was associated with a higher mortality in the Bulgarian cohort. Modern treatment options that induce a strict biochemical control and reduce the necessity of radiotherapy might influence the life expectancy. Other factors, possibly management of comorbidities, could contribute to survival rates.

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Section: Discussionsupporting

confidence: 92%

Could different treatment approaches in acromegaly influence life expectancy? A comparative study between Bulgaria and Campania (Italy)

Colao

Vandeva

Pivonello

et al. 2014

European Journal of Endocrinology

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“…Respiratory disorders account for up to 25% of causes of death, second only to cardiovascular events that contribute to 60% of mortality (2)(3)(4)(5). The most typical respiratory complication in acromegaly is sleep apnea (SA) that has only been recognized as part of the clinical spectrum of acromegaly within the last 15 years (6)(7)(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Prevalence of sleep apnea and metabolic abnormalities in patients with acromegaly and analysis of cephalometric parameters by magnetic resonance imaging.

Haute

Taboada

Corrêa

et al. 2008

European Journal of Endocrinology

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Objectives: To determine the prevalence of sleep apnea (SA) and SA syndrome (SAS) in patients with acromegaly and correlate SA with clinical, laboratory, and cephalometric parameters. Design and methods: Prospective and cross-sectional study of 24 patients with active acromegaly evaluated by clinical and laboratory (GH, IGF-I) parameters, polysomnography and magnetic resonance imaging (MRI) of the pharynx. Results: Out of 24 patients, 21 had SA (87.5%), of which 20 (95.3%) had the predominant obstructive type. Median age of these 21 patients was 54 years (range 23-75) and median estimated disease duration was 60 months (range 24-300). The frequency in SA patients of impaired glucose tolerance, diabetes mellitus (DM), and hypertension was 19, 33.3, and 71.4% respectively. Goiter was found in 10 patients (47.6%) and obesity in 18 (90%). Median GH level was 14 mg/l (1.4-198) and median %IGF-I (percentage above the upper limit of normal range of IGF-I) was 181% (K31.6 to 571.2). The prevalence of SAS was 52.4%. Apnea-hypopnea index (AHI) correlated significantly with age, waist circumference, body mass index, and hypopharynx area. The AHI was significantly higher in patients with hypertension and DM. Conclusions: The prevalence of SA and SAS in acromegaly was similar to the one previously described in other series. Age was a significant risk factor, and hypertension and DM were significantly associated complications of SA. Obesity was also significantly related to SA, as a risk factor, a complication or both. Overall, cephalometric parameters by MRI did not correlate with SA.European Journal of Endocrinology 158 459-465

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“…Key words: Acromegaly, Insulin-like growth factor I, Pituitary adenoma, Surgical outcome, Transsphenoidal surgery (Endocrine Journal 44: 395-402,1997) ALTHOUGH acromegaly is an uncommon disease, the average incidence rate being reported as 3.1-3.8/million inhabitants/year, it is associated with an increased mortality rate due to excess deaths from cardiorespiratory, cerebrovascular and malignant diseases [1][2][3] patients, whereas it was previously carried out in other hospitals twice and was once followed by bromocriptine and/or radiation treatment before our surgical treatment in the remaining 2 patients.…”

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confidence: 99%

The Results of Transsphenoidal Surgery for 44 Consecutive Acromegalic Patients.

et al. 1997

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Abstract.A series of 44 patients with acromegaly underwent transsphenoidal surgery between 1987 and 1996. The early postoperative mean basal GH level < 5 ng/ml or < 3 ng/ml was achieved in 43 (97.7%) or 38 (86.4%) out of 44 patients, respectively. Preoperative abnormal GH secretory response to TRH, GnRH and oral glucose administration was restored to normal both after surgery and at the time of the final follow-up in all patients whose early postoperative mean basal GH levels were reduced to < 3 ng/ ml, whereas they remained abnormal in those with mean basal GH levels of > 3 ng/ml. In contrast, insulin-like growth factor 1 (IGF-1) levels, when measured by the extraction method, tended to be reduced gradually to normal between 6 months and 2 years after surgery in some patients with a successful operation.Therefore, 34 (87.1%) out of 39 patients who have been followed up longer than 6 months met the following stringent criteria at the time of the final follow-up: mean basal GH level < 3 ng/ml, a normal IGF-1 level, and normal GH response to TRH, GnRH and oral glucose administration. In this series, the most unfavorable preoperative factor influencing operative outcome is tumor invasion of the cavernous sinus. Our results clearly indicate that selective adenomectomy by transsphenoidal surgery is the therapy of first choice in any patient with acromegaly and that the complete biochemical cure of acromegaly can be achieved in 87% of patients by surgery alone with an acceptable low surgical morbidity.

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Acromegaly: An epidemiological study

Cited by 151 publications

References 30 publications

Could different treatment approaches in acromegaly influence life expectancy? A comparative study between Bulgaria and Campania (Italy)

Could different treatment approaches in acromegaly influence life expectancy? A comparative study between Bulgaria and Campania (Italy)

Prevalence of sleep apnea and metabolic abnormalities in patients with acromegaly and analysis of cephalometric parameters by magnetic resonance imaging.

The Results of Transsphenoidal Surgery for 44 Consecutive Acromegalic Patients.

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