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Endocrine Abstracts (2021) 77 OP3.1 | DOI: 10.1530/endoabs.77.OP3.1

SFEBES2021 Oral Poster Presentations Reproductive and Neuroendocrinology (4 abstracts)

Discordant growth hormone and insulin like growth factor-1 values are associated with an increased mortality over concordant normal values in patients treated for acromegaly

Dayakshi Abeyaratne 1,2 , Sonia Kaniuka-Jakubowska 1,3 , Zoe Plummer 4 , Natasha Archer 4 , Chathuranga Lakmal Fonseka 5 , John Ayuk 6 , James Peter 7 , Richard McNally 8 , Stephen Michael Orme 9 , Aled Rees 10 , Aparna Pal 1 & John Wass 1


1Department of Endocrinology at the Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; 2Diabetes and Endocrinology Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka; 3Department of Endocrinology and Internal Medicine, Medical University of Gdansk, Gdansk, Poland; 4Society for Endocrinology, Bristol, United Kingdom; 5Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, Oxford, United Kingdom; 6Department of Endocrinology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; 7University of Newcastle, Newcastle, United Kingdom; 8Newcastle University, Newcastle, United Kingdom; 9St. James’s University Hospital, Leeds, Leeds, United Kingdom; 10Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, United Kingdom


Background: Growth hormone (GH) and Insulin like growth factor 1 (IGF-1) discordance in patients with acromegaly is a well-recognised phenomenon. It is unclear whether this is associated with increased mortality and morbidity compared to patients with concordant normal results.

Methodology: A retrospective study was conducted on the United Kingdom Acromegaly Registry (UKAR). A comparison of mortality and morbidity was performed among four groups categorised according to the latest simultaneously available GH and IGF-1 pair; 1) normal GH and IGF-1 (normalconc), 2) high GH and IGF-1 (highconc), 3) discordance with high GH and normal IGF-1 (GHdisc) 4) discordance with normal GH and high IGF-1 (IGF-1disc). High IGF-1 level was considered as >1.3 times upper limit of normal for age, gender matched centre specific reference range, while high GH level was considered as >1µg/dl.

Results: Out of all the patients (n = 2138, 41331 person-years of follow up) there were 1210,326,429,173 in normalconc, highconc, GHdisc and IGF-1disc groups, respectively. Overall mean discordance rate was 28.2% (range=5-47.4%) across 29 centres in the UK. Majority of discordance noted in GHdisc (71%). Both discordant groups showed lower median survival (GHdisc [35.5yrs,95%CI=32.4-38.7] and IGF-1disc [37.9yrs,29.6-46.1]) compared to normalconc (41.8yrs,37.7-45.8).Age and gender adjusted Hazard ratio (aHR) for mortality rate was higher in highconc (aHR=1.57;1.24-2.0; P < 0.001) and GHdisc (aHR=1.25;1.01-1.62;p=0.045) than normalconc, but was not significantly higher in IGF1disc group (aHR=1.41;0.98-2.02;p=0.062). No difference noted between the causes of death among groups. Morbidity analysis revealed, diabetes mellitus was higher in the IGF-1disc group than normalconc group (p <0.05).

Conclusions: This is the first data in a large number of acromegaly patients to show that discordance in GH and IGF-1, especially with high GH and normal IGF-1 is associated with a higher mortality than patients with normal levels. These findings have a significant implication in the management as they may require treatment escalation.

Volume 77

Society for Endocrinology BES 2021

Edinburgh, United Kingdom
08 Nov 2021 - 10 Nov 2021

Society for Endocrinology 

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