Predictors of morbidity and mortality in acromegaly: an Italian survey

Arosio, Maura; Reimondo, Giuseppe; Malchiodi, Elena; Berchialla, Paola; Borraccino, Alberto; Marinis, Laura De; Pivonello, Rosario; Grottoli, Silvia; Losa, Marco; Cannavò, Salvatore; Minuto, Francesco; Montini, M; Bondanelli, Marta; Menis, Ernesto De; Martini, Chiara; Angeletti, G; Velardo, A; Peri, Alessandro; Faustini‐Fustini, Marco; Tita, Patrizia; Pigliaru, Francesco; Borretta, Giorgio; Scaroni, Carla; Bazzoni, Nicoletta; Bianchi, Antonio; Appetecchia, Marialuisa; Cavagnini, Francesco; Lombardi, Gaetano; Ghigo, Ezio; Beck‐Peccoz, Paolo; Colao, Annamaria; Terzolo, Massimo

doi:10.1530/eje-12-0084

Cited by 187 publications

(180 citation statements)

References 42 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). They suggested that the improved survival rate could be due to more stringent criteria for remission and the introduction of modern and more efficient treatment options, such as SSAs and GHRAs.…”

Section: Discussionsupporting

confidence: 91%

“…A recent meta-analysis by Holdaway et al (7) has demonstrated that studies with O30% utilization of SSAs or O70% of remission rates reported normal life expectancy in contrast to higher mortality rates in those with lower percentages of SSA administration and remission rates. In line with these findings, the Campania cohort had a normal life expectancy -an SMR of 0.66 (95% CI 0.27-1.36; PZ0.269) in agreement with two recent studies concerning mortality among the Italian population (33,34,35). Owing to funding restrictions in Bulgaria, SSAs and GHRAs were not available in clinical practice until 2008 and none of the patients were under such Table 5 Characteristics of patients in the three treatment groups.…”

Section: Discussionsupporting

confidence: 86%

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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: 91%

Section: Discussionsupporting

confidence: 86%

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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“…3,10,11 In 15 studies, data were collected retrospectively from specialized centres, whereas 17 studies were designed in a prospective manner. Finally, data from four studies were retrieved in the setting of an intervention trial regarding the administration of SSAs in acromegalic patients.…”

Section: Data Reviewmentioning

confidence: 99%

The ongoing challenge of discrepant growth hormone and insulin‐like growth factor I results in the evaluation of treated acromegalic patients: a systematic review and meta‐analysis

Kanakis

Chrisoulidou

Bargiota

et al. 2016

Clinical Endocrinology

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SummaryObjective Growth hormone (GH) and insulin-like growth factor I (IGF-I) are the principal biomarkers used to assess disease activity in acromegaly, and any discrepancy between them renders interpretation of results inconclusive. Purpose of this study was to assess the frequency of this discrepancy and identify parameters that might affect its occurrence. Design A systematic review of MEDLINE and Scopus was performed followed by a meta-analysis to address the frequency of discrepant results between GH and IGF-I levels. Meta-regression and subgroup analyses were performed assessing the effects of the year of publication, the different types of GH testing and GH assays used, as well as the impact of treatment with somatostatin analogues (SSAs) on the occurrence of this discrepancy. Results The analysis retrieved 39 eligible studies totalling 7071 patients. The pooled discordance rate between GH and IGF-I was 25Á7% (95% CI: 22Á3-29Á4), and the predominant format was that of elevated IGF-I with normal GH levels (15Á3%, 95% CI: 12Á5-18Á7). No significant correlation between the discordance rate and the year of publication was shown; whereas, the use of ultrasensitive GH assays resulted in higher discordance rates (30Á7%, 95% CI: 25Á9-35Á9 vs 19Á8%, 95% CI: 14Á1-27Á2, P = 0Á04) as did treatment with SSAs (32Á5%, 95% CI: 27Á8-37Á4) vs (21Á6%, 95% CI: 17Á8-25Á6, P = 0Á001).Conclusions Discrepancy between GH and IGF-I results is encountered in a quarter of treated patients with acromegaly, especially when using ultrasensitive GH assays or in patients receiving SSAs, a fact that the clinician should take into consideration when making clinical decisions.

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“…When surgery fails or is contraindicated, adjunctive therapy is needed, mainly somatostatin analogues and, to a lesser extent, dopamine agonists, growth hormone (GH) receptor antagonists or radiotherapy, as recommended in several recent consensus guidelines (1,4,5,6). These treatments usually control the disease effectively, and normalising levels of GH and insulin-like growth factor 1 (IGF1) should reduce the excess morbidity and mortality associated with acromegaly (4,7,8). However, recent studies have shown that there was a relatively low percent of patients with acromegaly who might be cured after withdrawal of somatostatin analogues (up to 20%) (9,10).…”

Section: Introductionmentioning

confidence: 99%

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

Delemer

Chanson

Foubert

et al. 2014

European Journal of Endocrinology

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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.

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Predictors of morbidity and mortality in acromegaly: an Italian survey

Abstract: Pretreatment IGF1 levels are important predictors of morbidity and mortality in acromegaly. The full hormonal control of the disease, nowadays reached in the majority of patients with modern management, reduces greatly the disease-related mortality.

Cited by 187 publications

References 42 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)

The ongoing challenge of discrepant growth hormone and insulin‐like growth factor I results in the evaluation of treated acromegalic patients: a systematic review and meta‐analysis

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

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