Long‐term outcome and mortality after transsphenoidal adenomectomy for acromegaly

Beauregard, Caroline; Truong, Uyen; Hardy, Jules; Serri, Omar

doi:10.1046/j.1365-2265.2003.01679.x

Cited by 282 publications

(215 citation statements)

References 18 publications

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“…Median age at death in the Belgian survey (68 years in men and 74 years in women) is higher than reported in previous series: 60 years in REA (12), 61 years in Quebec (8) and New Zealand (6), but close to the 64 years for men and 69 years for women in Finland (5) and the 66 years in the West Midlands database (4). By comparison, current life expectancy in Belgium is 75.6 in men and 81.7 years in women.…”

Section: Discussioncontrasting

confidence: 48%

“…This difference is probably due to selection bias as ultrasound is not systematically performed in every day clinical care, especially if patients are not treated with SSA. On the other hand, the reported prevalence of overt diabetes mellitus (25%), previously reported to be 9-23% (19), is lower than in REA (38%) and in a Canadian study (40%) (8). Underreporting is unlikely, as the non-diabetic patients had normal glucose and HbA1c values at the time of the survey.…”

Section: Discussioncontrasting

confidence: 40%

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AcroBel – the Belgian registry on acromegaly: a survey of the ‘real-life’ outcome in 418 acromegalic subjects

Bex¹,

et al. 2007

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Objectives: To constitute a registry on acromegaly, AcroBel, to evaluate the epidemiology and quality of care of acromegaly in Belgium and Luxembourg. Design: A nationwide survey from June 2003 till September 2004 aiming to collect data from all patients with acromegaly who had visited the participating endocrine clinics after 1 January 2000. Methods: Retrospective data collection coupled to a visit within the survey period, allowing sampling of metabolic parameters and centralised determination of GH and IGF-I. Results: Four hundred and eighteen patients (51% men) were included, of which 96 were new cases, giving a mean incidence of 1.9 cases per million (c.p.m.) per year. The global prevalence was 41 c.p.m. but varied between 21 and 61 among different areas. Twenty-eight deaths were reported at a median age of 68 years in men and 74 years in women. The standardised mortality rate was significantly increased only in irradiated patients (2.70; confidence interval 1.60-4.55). Central measurements were available in 316 (75%) patients. Mean GH was %2 mg/l in 65% and IGF-I was normal for age in 56%, while both criteria were fulfilled in 49%. Multimodal treatment was more effective than primary medical therapy, since 56.5% were controlled versus 24.3% (P!0.0001). Conclusions: AcroBel provides an excellent tool to analyse the prevalence, incidence, treatment modalities and outcome of acromegaly in Belgium. This real-life survey reveals that only half of acromegalic patients received an adequate therapy resulting in cure or disease control when stringent biochemical criteria are used.

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Section: Discussioncontrasting

confidence: 48%

Section: Discussioncontrasting

confidence: 40%

AcroBel – the Belgian registry on acromegaly: a survey of the ‘real-life’ outcome in 418 acromegalic subjects

Bex¹,

et al. 2007

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“…Bates et al (38) were the first to demonstrate that an increased mortality was reduced to normal when GH levels reached !2.5 mg/l. Their observations were supported by numerous further studies (22,26,27,28,29,30,32,38,39) with a pooled SMR of 1.1 (0.9-1.4; PZ0.50) (7). Some research groups reported even lower GH targets: 2 mg/l by Ayuk et al and a further improvement in mortality when GH was reduced to !1 mg/l (23,26).…”

Section: Clinical Studysupporting

confidence: 56%

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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“…15,22 For most patients, transsphenoidal adenomectomy (TSA) by a dedicated and experienced pituitary neurosurgeon is the first-line treatment option. [23][24][25][26] In addition to surgical treatment, the American Association of Clinical Endocrinologists (AACE) reviews the pharmacological options for the treatment of acromegaly and recommends medical therapy for the treatment of persistent acromegaly and for treatment of patients who are not candidates for surgery. 3,21 The options for medical therapy include: somatostatin analogs, dopaminereceptor agonists, and GH-receptor analogs.…”

Section: Acromegalymentioning

confidence: 99%

Safety review: Dose optimization of somatostatin analogs in patients with acromegaly and neuroendocrine tumors

Ludlam

Anthony

2011

Adv Therapy

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Long‐term outcome and mortality after transsphenoidal adenomectomy for acromegaly

Abstract: Our observations confirm that uncontrolled acromegaly increases mortality compared to the general population and that mortality rates similar to the general population are restored once remission is induced.

Cited by 282 publications

References 18 publications

AcroBel – the Belgian registry on acromegaly: a survey of the ‘real-life’ outcome in 418 acromegalic subjects

AcroBel – the Belgian registry on acromegaly: a survey of the ‘real-life’ outcome in 418 acromegalic subjects

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

Safety review: Dose optimization of somatostatin analogs in patients with acromegaly and neuroendocrine tumors

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