Diabetes in acromegaly, prevalence, risk factors, and evolution: data from the French Acromegaly Registry

Objective: Patients with active acromegaly have an increased prevalence of cardiomyopathy and heart failure but a less than expected risk of coronary artery disease, considering the frequent association of diabetes mellitus and hypertension. We examined whether changes in high-sensitive C-reactive protein (hs-CRP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) might contribute to this phenomenon. Design and methods: Two hundred patients of the Belgian acromegaly registry (AcroBel) were divided in two groups: active disease (IGF1 Z-score O2; nZ95) and controlled disease (IGF1 Z-score %2; nZ105). Serum levels of hs-CRP and NT-proBNP were measured and correlated with BMI, blood pressure, fasting lipids, fasting glucose and insulin, HbA1c, IGF1, interleukin 6 (IL6), adiponectin, and sE-selectin. In a subset of acromegaly patients, hs-CRP, IL6, and NT-proBNP levels were also compared with those/the values of an age-, gender-, and BMI-matched reference group.

Section: Discussionsupporting

confidence: 69%

Active acromegaly is associated with decreased hs-CRP and NT-proBNP serum levels: insights from the Belgian registry of acromegaly

Verhelst

Velkeniers²,

Maiter

et al. 2013

“…Importantly, however, increased morbidity was also evident in the 3-year prediagnostic period, adding new support to observations that the prediagnostic phase of acromegaly is sizeable and contributes to morbidity (27,30,31,32,33). This phenomenon, and also the highest mortality risk in the first year after diagnosis, might point towards reduction in morbidity and mortality due to effective treatment.…”

Section: Discussionsupporting

confidence: 55%

Acromegaly incidence, prevalence, complications and long-term prognosis: a nationwide cohort study

Dal

Feldt‐Rasmussen

Andersen

et al. 2016

163

125

Design: Valid data on acromegaly incidence, complications and mortality are scarce. The Danish Health Care System enables nationwide studies with complete follow-up and linkage among health-related databases to assess acromegaly incidence, prevalence, complications and mortality in a population-based cohort study. Method: All incident cases of acromegaly in Denmark (1991Denmark ( -2010 were identified from health registries and validated by chart review. We estimated the annual incidence rate of acromegaly per 10 6 person-years (py) with 95% confidence intervals (95% CIs). For every patient, 10 persons were sampled from the general population as a comparison cohort. Cox regression and hazard ratios (HRs) with 95% confidence intervals (95% CIs) were used. Results: Mean age at diagnosis (48.7 years (CI: 95%: 47.2-50.1)) and annual incidence rate (3.8 cases/10 6 persons (95% CI: 3.6-4.1)) among the 405 cases remained stable. The prevalence in 2010 was 85 cases/10 6 persons. The patients were at increased risk of diabetes mellitus (HR: 4.0 (95% CI: 2.7-5.8)), heart failure (HR: 2.5 (95% CI: 1.4-4.5)), venous thromboembolism (HR: 2.3 (95% CI: 1.1-5.0)), sleep apnoea (HR: 11.7 (95% CI: 7.0-19.4)) and arthropathy (HR: 2.1 (95% CI: 1.6-2.6)). The complication risk was also increased before the diagnosis of acromegaly. Overall mortality risk was elevated (HR: 1.3 (95% CI: 1.0-1.7)) but uninfluenced by treatment modality. Conclusion: (i) The incidence rate and age at diagnosis of acromegaly have been stable over decades, and the prevalence is higher than previously reported.(ii) The risk of complications is very high even before the diagnosis.(iii) Mortality risk remains elevated but uninfluenced by mode of treatment.

“…The quality of the follow-up is therefore a major issue. The French consensus on the management of acromegaly, developed by the French Endocrinology Society, recommends an annual consultation with a specialist and regular defined tests (12,13). This is especially important since drug therapy for acromegaly is usually inconvenient and expensive (14).…”

Section: Discussionmentioning

confidence: 99%

Patients lost to follow-up in acromegaly: results of the ACROSPECT study

Delemer

Chanson

Foubert

et al. 2014

Objective: The complex management of acromegaly has transformed this disease into a chronic condition, with the risk of patients being lost to follow-up. The objective of this study was to estimate the proportion of acromegalic patients lost to follow-up in France and to determine the impact that abandoning follow-up has on the disease and its management. Design: ACROSPECT was a French national, multicentre, cross-sectional, observational study. Methods: Acromegalic patients were considered lost to follow-up if no new information had been entered in their hospital records during the previous 2 years. They were traced where possible, and data were collected by means of a recall visit or questionnaire. Results: In the study population, 21% of the 2392 acromegalic patients initially followed in 25 tertiary endocrinology centres were lost to follow-up. At their last follow-up visit, 30% were uncontrolled, 33% were receiving medical therapy and 53% had residual tumour. Of the 362 traced, 62 had died and 77% were receiving follow-up elsewhere; the leading reason for abandoning follow-up was that they had not been informed that it was necessary. Our analysis of the questionnaires suggests that they were not receiving optimal follow-up. Conclusions: This study underlines the need to better inform acromegalic patients of the need for long-term follow-up, the absence of which could be detrimental to patients' health, and to develop shared care for what must now be regarded as a chronic disease.