Acromegaly increases excess mortality, though rates may be declining

CHICAGO — Adults with acromegaly have an increased risk for excess morbidity and mortality, especially related to circulatory and malignant diseases, according to a presenter at the Endocrine Society Annual Meeting.

Daniela Esposito, MD, of the department of endocrinology at Sahlgrenska University Hospital in Gothenburg, Sweden, and colleagues evaluated data from the Swedish National Health Registries from 1987 to 2013 on 1,089 adults with acromegaly to determine mortality and trends in mortality and treatment patterns. The mean age at diagnosis was 52 years. The study population was divided into three periods: 1987-1995 (first), 1996-2004 (second) and 2005-2013 (last) for time trend analyses. Mean follow-up was 11.8 years.

Overall, 64% of participants underwent surgery and 13% underwent radiotherapy. The researchers observed a trend of increasing frequency of pituitary surgery over time, from 58% in 1987-1995 to 63% in 1996-2004 to 72% in 2005-2013 (P for trend < .001). A similar trend was observed in radiotherapy, from 10% in the earliest period to 15% in the most-recent period (P = for trend = .1). The prevalence of hypopituitarism decreased from 41% in 1987-1995 to 23% in 2005-2013 (P for trend < .001).

During the entire study period, the standardized mortality ratio (SMR) was 2.79 (95% CI, 2.43-3.15), In total, 232 observed and 83 expected deaths occurred. Excess mortality decreased over time, from 1987-1995 (SMR = 3.45; 95% CI, 2.87-1.02) to 1996-2004 (SMR = 2.28; 95% CI, 1.76-2.81) to 2005-2013 (SMR = 1.86; 95% CI, 1.04-2.67). The most common causes of excess mortality were malignancy (SMR = 1.76; 95% CI, 1.27-2.26) and circulatory diseases (SMR = 1.95; 95% CI, 2.35-3.55), including ischemic heart disease (SMR = 2; 95% CI, 1.35-2.66) and cerebrovascular disease (SMR = 3.99; 95% CI, 2.42-5.55).

Among 338 participants evaluated in 2005-2013 (163 men), 45% had a record of pharmacotherapy for acromegaly. The most common treatment was somatostatin analogues (35%), followed by dopamine agonists (15%) and growth hormone receptor antagonists (9%). There was no difference in type of medication between women and men.

In this group of 338 patients diagnosed since 2005, the standardized mortality ratio was 2.03 (95% CI, 0.62-3.44) among those treated with medication only, 0.98 (95% CI, 0-2.3%) among those treated with both medication and surgery, and 0.45 (95% CI, 0-1.08) among those treated with surgery only.

“This is a nationwide study with the largest population of acromegaly patients so far,” Esposito said during her presentation. “We recorded excess mortality in our patients that were mainly related to circulatory disease, including cerebrovascular disease and ischemic heart disease, and malignancies. Mortality gradually and significantly decreased in subjects throughout the study period suggesting a role of improved management in acromegaly; this may be explained by improved pituitary surgery as well as the addition of new treatment options.” – by Amber Cox

Reference:

Esposito D, et al. OR06-1. Presented at: The Endocrine Society Annual Meeting; March 17-20, 2018; Chicago.

Disclosures: Esposito reports she receives lecture fees from Ipsen. Please see the study for all other authors’ relevant financial disclosures.