Endocrine Abstracts

This study presents epidemiological data of 1512 Italian acromegalic patients who had been diagnosed from 1980 to 2002 and followed-up for more than 10 years, retrospectively collected by 24 tertiary referral centers. Data on co-morbidities and mortality were compared to those of the general Italian population obtained by the Italian National Institute of Statistic. At diagnosis median age of patients (41% M, 59% F) was 46 years, GH (mean±S.D.) 31±37 mcg/l, IGF1 744±318 ng/ml (median SDS 8.53, IQR 5.82–12.34). Diabetes mellitus was reported in 16% of cases, hypertension in 33%. Older age and higher IGF1 but not GH levels at diagnosis were significant predictors of diabetes and hypertension. The patients were treated by surgery (80%), pharmacotherapy (75%), radiotherapy (18%), radiosurgery (6%) alone or in combination. The prevalence of neoplastic diseases (all causes) was significantly higher than in the general population. Older patients who had a greater delay of diagnosis and previous radiotherapy were also at higher risk to develop a neoplasm. Diabetes was a significant risk factor for neoplasm in the univariate analysis, only. At last follow-up 65% of patients had a controlled disease, with 55% off medical treatment. Multivariate analysis showed that male gender, extrasellar adenoma and high GH at diagnosis were predictors of disease persistence. Observed deaths were 61, with a standardized mortality ratio (SMR) of 1.13 (95% CI: 0.87–1.46). Mortality was significantly higher in the patients with persistently active disease (SMR 1.93; 95% CI: 1.34–2.70). Main causes of deaths were vascular diseases and malignancies with similar prevalence. Older age, higher GH at last follow-up, higher IGF1 levels at diagnosis, malignancies and radiotherapy were independent predictors of mortality.

In conclusion: basal IGF1 levels are important predictors of morbidity and mortality in acromegaly. The delay of diagnosis increases the risk to develop a neoplasm. The full hormonal control of the disease, nowadays reached in the majority of the patients, reverses the increased mortality.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.