Wpływ cukrzycy na przeżycie pacjentów z akromegalią

Abstract

Introduction: An increased risk of mortality in patients with uncontrolled acromegaly has been reported in several studies. We aimed to assess the impact of co-morbidities on the survival of patients with acromegaly after long-term treatment and follow-up. Materials and methods: A retrospective analysis was performed for 285 patients with active acromegaly, who were admitted to the Chang Gung Memorial Hospital, Taiwan between 1978 and 2012. Of these patients, 106 (37.2%) were diagnosed with diabetes mellitus (DM). During the follow-up period, 21 cases of histological proved malignant in acromegalic patients, and DM with acromegaly had a higher incidence of malignancy (13.2% vs. 3.8%; p < 0.01). The 5-, 10-, and 20-year survival rates were 93.1%, 86.9%, and 84.7% for the DM group, respectively, and 96.5%, 96.5%, and 96.5% for the non-DM group, respectively. After a mean follow-up of 15.1 ± 0.6 years, age, DM, coronary heart disease, and malignancy were found to be significant factors of mortality. Control of growth hormone and IGF-1 levels also conferred a marginal survival benefit. Conclusions: DM and malignancy significantly influence the survival of patients with acromegaly; thus, these patients need close follow-up and appropriate therapy.

Disorders of carbohydrate metabolism and their relationship with the prevalence of cancer in patients with acromegaly – authors’ own observations

“…wen-ko et al demonstrated a shorter survival time of patients with acromegaly and diabetes compared with a subgroup with acromegaly without diabetes, while levels of gh and igF-1 in patients with diabetes were only slightly higher (to a statistically insignificant extent) [12]. these researchers also confirmed a lower percentage of surgically treated patients in the subgroup with concomitant diabetes [12].…”

“…(37.2%) [12] or zieleniewski and Michalak -(32%) [13] and in a percentage higher than Valea et al -12% [7]. these differences probably result from different criteria of the diagnosis of disorders of carbohydrate tolerance adapted in different countries, as well as different patient populations (prospective and retrospective studies, different geographic zones, eating habits, bMi, age), but all the studies clearly demonstrate the importance of the problem.…”

“…therefore, the most serious complications of acromegaly, especially with concomitant diabetes, are cancers, mainly of the gastrointestinal tract, but also of other organs: breast, prostate, brain [2,9,10,13,16]. in the group of 106 patients suffering from acromegaly with concomitant diabetes, wen-ko et al demonstrated a higher prevalence of cancers as compared to patients with acromegaly without diabetes (13.2% vs. 3.5%; p < 0.01) [12].…”

Growth hormone, insulin-like growth factor system and carcinogenesis

“…The comparison between older and more recent occurrences of the disease is challenging because both cancer incidence in the general population and life expectancy in patients with acromegaly have dramatically changed over the past few decades, influencing the prevalence of disease-associated morbidities. In fact, recent series have found cancer as a common cause of death and an independent predictor of mortality in acromegaly [75][76][77][78]. In addition, population-based cancer registries and epidemiology may vary from site to site.…”

Cardiometabolic Risk in Acromegaly: A Review With a Focus on Pasireotide

“…The frequency of diabetes mellitus (DM) ranges from 16 to 56%; impaired glucose tolerance (IGT) from 6 to 45%; and impaired fasting glucose (IFG) from 7 to 22% (3). In patients with acromegaly, DM occurs at a younger age than in the general population (15,16), and is associated with a worse prognosis (16,17). It is worthy of note that the development of glucose metabolism abnormalities is associated with disease duration and severity, but they often occur in the earliest phases of acromegaly (14).…”