Increased mortality in acromegaly is due to vascular and respiratory disease and is normalised by control of GH levels-a retrospective analysis from the UK acromegaly register 1970-2016
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Department of Endocrinology, Christie Hospital NHS Foundation Trust, Division of Cancer Sciences, University of Manchester, Manchester, UK.Issue Date
2024
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CONTEXT: Epidemiological studies involving patients with acromegaly have yielded conflicting results regarding cancer incidence and causes of mortality in relation to control of growth hormone (GH) excess. OBJECTIVE: The objective of this retrospective cohort study is to clarify these questions and identify goals for treatment and monitoring patients. METHODS: We studied 1845 subjects from the UK Acromegaly Register (1970-2016), obtaining cancer standardised incidence rates (SIR) and all causes standardised mortality rates (SMR) from UK Office for National Statistics, to determine the relationship between causes of mortality-age at diagnosis, duration of disease, post-treatment and mean GH levels. RESULTS: We found an increased incidence of all cancers (SIR, 1.38; 95% CI: 1.06-1.33, p < .001), but no increase in incidence of female breast, thyroid, colon cancer or any measure of cancer mortality. All-cause mortality rates were increased (SMR, 1.35; 95% CI: 1.24-1.46, p < .001), as were those due to vascular and respiratory diseases. All-cause, all cancer and cardiovascular deaths were highest in the first 5 years following diagnosis. We found a positive association between post-treatment and mean treatment GH levels and all-cause mortality (p < .001 and p < .001), which normalised with posttreatment GH levels of <1.0 µg/L or meantreatment GH levels of <2.5 µg/L. CONCLUSION: Acromegaly is associated with increased incidence of all cancers but not thyroid or colon cancer and no increase in cancer mortality. Excess mortality is due to vascular and respiratory disease. The risk is highest in the first 5 years following diagnosis and is mitigated by normalising GH levels.Citation
Orme S, McNally R, James PW, Davis J, Ayuk J, Higham C, et al. Increased mortality in acromegaly is due to vascular and respiratory disease and is normalised by control of GH levels-A retrospective analysis from the UK Acromegaly Register 1970-2016. Clinical endocrinology. 2024 Jun;100(6):558-64. PubMed PMID: 38652736. Epub 2024/04/23. eng.Journal
Clinical Endocrinology (Oxford)DOI
10.1111/cen.15060PubMed ID
38652736Additional Links
https://dx.doi.org/10.1111/cen.15060Type
ArticleLanguage
enae974a485f413a2113503eed53cd6c53
10.1111/cen.15060
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