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Multimodal approach to acromegaly reduced mortality
The use of a multimodal approach that addresses biochemical factors and controls comorbidities can result in reduced mortality among patients with acromegaly, according to recent findings.
In the retrospective study, researchers evaluated 442 patients (65.4% female) seen for treatment at the Acromegaly Clinical at Hospital de Especialidades, a multidisciplinary clinic in Mexico that provides diagnostic testing and long-term pharmacological, neurosurgical and radiotherapeutic treatment of acromegaly.
Overall, there were 22 deaths during the study period (4.9%), which equaled a standardized mortality ratio (SMR) of 0.72. Patients whose last measured growth hormone levels were >2.5 ng/mL had SMRs of 1.5 compared with 0.44 among those whose last growth hormone levels were <2.5 ng/mL. Patients with a last growth hormone >1 ng/mL had SMRs of 1.17 compared with 0.15 among those with growth hormone levels <1 ng/mL.
Patients whose last insulin-like growth factors 1 (IGF-1) levels were >1.2 times the upper limit of normal had SMRs of 0.94 compared with 0.46 among those with IGF-1 levels <1.2 times the upper limit of normal.
The comorbidity rates were diabetes mellitus (30%), hypertension (35%), heart disease (8%) and cancer (4.7%). Cancer was determined to be the most prevalent cause of death. Multivariate analysis revealed an association between growth hormone levels >10 ng/mL at baseline and diabetes, heart disease and cancer.
Survival was compromised in patients whose latest growth hormone levels increased from <1 ng/mL to >5 ng/mL and when IGF-1 increased from <1.2 to >2 times the upper limit of normal. Survival decreased when patients’ latest growth hormone levels increased from <1 ng/mL to >5 ng/mL. Cancer and latest IGF-1 were found to be independently predictive of mortality.
“In conclusion, mortality in acromegaly can be reduced when patients are managed at specialized centers using a multimodal approach,” the researchers wrote. “A comprehensive strategy that aims at controlling both, the deranged [growth hormone] /IGF-1 system as well as the specific comorbidities of the disease not only results in an increased survival of these patients, but also in a significant improvement in their [quality of life].”
Disclosure: The researchers report no relevant financial disclosures.