Disease control of acromegaly does not prevent excess mortality in the long term: results of a nationwide survey in Italy

TL;DR

This study found that even with disease control, people with acromegaly still face higher long-term mortality compared to the general population.

Contribution

The study shows that disease control does not prevent excess mortality in acromegaly over the long term.

Findings

Patients with acromegaly had a 70% higher mortality rate than the general population.

Mortality remained elevated even in patients with controlled disease.

Oncological causes of death were more common than cardiovascular ones in this cohort.

Abstract

This study aimed to assess the long-term outcome of patients with acromegaly.

This is a multicenter, retrospective, observational study which extends the mean observation period of a previously reported cohort of Italian patients with acromegaly to 15 years of follow-up.

Only patients from the centers that provided information on the life status of at least 95% of their original cohorts were included. Life status information was collected either from clinical records or from the municipal registry offices. Standardized mortality ratios (SMRs) were computed comparing data with those of the general Italian population.

A total of 811 patients were included. There were 153 deaths, with 90 expected and an SMR of 1.7 (95% CI 1.4–2.0, p < 0.001). Death occurred after a median of 15 (women) or 16 (men) years from the diagnosis, without gender differences. Mortality remained elevated in the patients with control of disease (SMR 1.3, 95% CI 1.1–1.6). In the multivariable analysis, only older age and high IGF1 concentrations at last available follow-up visit were predictors of mortality. The oncological causes of death outweighed the cardiovascular ones, bordering on statistical significance with respect to the general population.

Mortality remains significantly high in patients with acromegaly, irrespectively of disease status, as long as the follow-up is sufficiently long with a low rate of patients lost to follow-up. Therapy strategy including radiotherapy does not have an impact on mortality. Oncological causes of death currently outweigh the cardiovascular causes.

The online version contains supplementary material available at 10.1007/s40618-023-02257-3.