Elina Ritvonen1, Eliisa Löyttyniemi2, Pia Jaatinen3, Tapani Ebeling4, Leena Moilanen5, Pirjo Nuutila6, Ritva Kauppinen-Mäkelin7, Camilla Schalin-Jäntti8. 1. Division of EndocrinologyAbdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. 2. Department of BiostatisticsUniversity of Turku, Turku, Finland. 3. School of MedicineUniversity of Tampere, Tampere, Finland Department of Internal MedicineTampere University Hospital, Tampere, Finland Department of Internal MedicineSeinäjoki Central Hospital, Seinäjoki, Finland. 4. University of OuluOulu, Finland Oulu University HospitalOulu, Finland. 5. University of Eastern FinlandKuopio, Finland Kuopio University HospitalKuopio, Finland. 6. Turku PET centreUniversity of Turku, Turku, Finland Department of EndocrinologyTurku University Hospital, Turku, Finland. 7. Center of Internal Medicine and RehabilitationJorvi Hospital, Helsinki University Hospital, Helsinki, Finland. 8. Division of EndocrinologyAbdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland camilla.schalin-jantti@hus.fi.
Abstract
OBJECTIVE: It is unclear whether mortality still is increased in acromegaly and whether there are gender-related differences. We dynamically assessed outcome during long-term follow-up in our nationwide cohort. PATIENTS AND METHODS: We studied standardized mortality ratios (SMRs) relative to the general population and causes of death in acromegaly (n=333) compared with age- and gender-matched controls (n=4995). RESULTS: During 20 (0-33) years follow-up, 113 (34%) patients (n=333, 52% women) and 1334 (27%) controls (n=4995) died (P=0.004). SMR (1.9, 95% CI: 1.53-2.34, P<0.001) and all-cause mortality (OR 1.6, 95% CI: 1.2-2.2, P<0.001) were increased in acromegaly. Overall distribution of causes of death (P<0.001) differed between patients and controls but not cardiovascular (34% vs 33%) or cancer deaths (27% vs 27%). In acromegaly, but not in controls, causes of deaths shifted from 44% cardiovascular and 28% cancer deaths during the first decade, to 23% cardiovascular and 35% cancer deaths during the next two decades. In acromegaly, cancer deaths were mostly attributed to pancreatic adenocarcinoma (n=5), breast (n=4), lung (n=3) and colon (n=3) carcinoma. In acromegaly, men were younger than women at diagnosis (median 44.5 vs 50 years, P<0.001) and death (67 vs 76 years, P=0.0015). Compared with controls, women (36% vs 25%, P<0.01), but not men (31% vs 28%, P=0.44), had increased mortality. CONCLUSIONS: In acromegaly, men are younger at diagnosis and death than women. Compared with controls, mortality is increased during 20 years of follow-up, especially in women. Causes of deaths shift from predominantly cardiovascular to cancer deaths.
OBJECTIVE: It is unclear whether mortality still is increased in acromegaly and whether there are gender-related differences. We dynamically assessed outcome during long-term follow-up in our nationwide cohort. PATIENTS AND METHODS: We studied standardized mortality ratios (SMRs) relative to the general population and causes of death in acromegaly (n=333) compared with age- and gender-matched controls (n=4995). RESULTS: During 20 (0-33) years follow-up, 113 (34%) patients (n=333, 52% women) and 1334 (27%) controls (n=4995) died (P=0.004). SMR (1.9, 95% CI: 1.53-2.34, P<0.001) and all-cause mortality (OR 1.6, 95% CI: 1.2-2.2, P<0.001) were increased in acromegaly. Overall distribution of causes of death (P<0.001) differed between patients and controls but not cardiovascular (34% vs 33%) or cancer deaths (27% vs 27%). In acromegaly, but not in controls, causes of deaths shifted from 44% cardiovascular and 28% cancer deaths during the first decade, to 23% cardiovascular and 35% cancer deaths during the next two decades. In acromegaly, cancer deaths were mostly attributed to pancreatic adenocarcinoma (n=5), breast (n=4), lung (n=3) and colon (n=3) carcinoma. In acromegaly, men were younger than women at diagnosis (median 44.5 vs 50 years, P<0.001) and death (67 vs 76 years, P=0.0015). Compared with controls, women (36% vs 25%, P<0.01), but not men (31% vs 28%, P=0.44), had increased mortality. CONCLUSIONS: In acromegaly, men are younger at diagnosis and death than women. Compared with controls, mortality is increased during 20 years of follow-up, especially in women. Causes of deaths shift from predominantly cardiovascular to cancer deaths.
Authors: Adriana G Ioachimescu; Talin Handa; Neevi Goswami; Adlai L Pappy; Emir Veledar; Nelson M Oyesiku Journal: Endocrine Date: 2019-11-01 Impact factor: 3.633
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Authors: Eva C Coopmans; Mark R Postma; Thalijn L C Wolters; Sebastiaan W F van Meyel; Romana Netea-Maier; André P van Beek; Sebastian J C M M Neggers Journal: J Clin Endocrinol Metab Date: 2021-05-13 Impact factor: 5.958