Association between biochemical control and comorbidities in patients with acromegaly: an Italian longitudinal retrospective chart review study

Abstract

Purpose Achieving biochemical control (normalization of insulin-like growth factor-1 [IGF-1] and growth hormone [GH]) is a key goal in acromegaly management. However, IGF-1 and GH fluctuate over time. The true potential impact of time-varying biochemical control status on comorbidities is unclear and relies on multiple, longitudinal IGF-1 and GH measurements. This study assessed the association between time-varying biochemical control status and onset of selected comorbidities in patients with acromegaly. Methods Medical charts of adults with confirmed acromegaly and ≥ 6 months of follow-up at an Italian endocrinology center were reviewed. Patients were followed from the first diagnosis of acromegaly at the center until loss to follow-up, chart abstraction, or death. Biochemical control status was assessed annually and defined as IGF-1 ≤ the upper limit of normal, or GH ≤ 2.5 µg/L in the few cases where IGF-1 was unavailable. Time-varying Cox models were used to assess the association between biochemical control status and comorbidities. Results Among 150 patients, 47% were female, average age at diagnosis was 43.1, and mean length of follow-up was 10.4 years. Biochemical control was significantly associated with a lower hazard of diabetes (HR = 0.36, 95% CI 0.15; 0.83) and cardiovascular system disorders (HR = 0.54, 95% CI 0.31; 0.93), and a higher hazard of certain types of arthropathy (HR = 1.68, 95% CI 1.04; 2.71); associations for other comorbidities did not reach statistical significance. Conclusion Results further support the importance of achieving biochemical control, as this may reduce the risk of highburden conditions, including diabetes and cardiovascular system disorders. The association for arthropathy suggests irreversibility of this impairment. Due to limitations, caution is required when interpreting these results.

Burden of acromegaly in the United States: increased health services utilization, location of care, and costs of care

“…The information on health services utilization seems to indicate the potential for improved management of acromegaly. Previous studies have also consistently demonstrated that effective biochemical control of IGF-1 can help mitigate or reduce the effects of these comorbid conditions (as well as the acromegaly itself) and improve symptoms [32][33][34]. This could translate into ramifications for patterns of care implementation, intensity of care, and overall health expenditures.…”

A Pituitary Society update to acromegaly management guidelines

“…A retrospective study of 150 patients treated at a single center for a median of 10.4 years [ 22 ] assessed treatment and disease control impact on acromegaly comorbidities. Biochemical control, assessed only by a random growth hormone (GH) level < 2.5 μg/L, was associated with a lower hazard ratio (HR) of developing DM (HR 0.36; 95% CI 0.15, 0.83; p = 0.017) as well as cardiovascular system disorders overall (HR 0.54; 95% CI 0.31, 0.93; p = 0.027) compared to those not controlled.…”

“…Biochemical control, assessed only by a random growth hormone (GH) level < 2.5 μg/L, was associated with a lower hazard ratio (HR) of developing DM (HR 0.36; 95% CI 0.15, 0.83; p = 0.017) as well as cardiovascular system disorders overall (HR 0.54; 95% CI 0.31, 0.93; p = 0.027) compared to those not controlled. However, the risks of developing arterial hypertension and myocardial hypertrophy were not different [ 22 ]. An increased risk of arthropathy was also noted (HR 1.68; 95% CI 1.04, 2.71; p = 0.032), suggesting that, once established, structural changes are less likely to be influenced by biochemical control.…”

The Effect of 6 Months’ Treatment With Pasireotide LAR on Glucose Metabolism in Patients With Resistant Acromegaly in Real-World Clinical Settings

“…As the morbidity and mortality rate in acromegaly is significantly associated with IGF-1 and GH level, the aim of medical therapy is to ensure target IGF-1 level within age- and gender-specific normal ranges and to lower and normalize GH levels ( 1 – 4 ). Biochemical control of acromegaly assessed by a random GH level <2.5 µg/L in a recently published longitudinal study was associated with a significantly lower risk of developing diabetes mellitus as well as cardiovascular system disorders overall compared to those not controlled ( 5 ).…”