Mortality and Morbidity in Acromegaly: Impact of Disease Control

Abstract

The excess production of growth hormone (GH) and insulin-like growth factor-I (IGF-I) in patients with acromegaly is associated with a range of complications which have important effects on quality of life and which lead to reduced life expectancy. The increased mortality of the disorder has been recognized in 18 studies, totaling 4,806 individuals with acromegaly and including 1,116 deaths during follow-up, with meta-analyses indicating a standardized mortality estimate of 1.7 (95% CI 1.5-2). Univariate and multivariate analyses within the individual studies have identified the presence of hypertension, diabetes, and cardiac disease as important predictors of survival, as well as estimated duration from onset of the condition to date of effective treatment. However, the most important impact on survival comes from reduction of circulating GH and IGF-I concentrations, with serum GH measured by radioimmunoassay of <2.5 mu g/L and a serum IGF-I measurement within the normal range for age providing mortality estimates indistinguishable from the general population. The major comorbidities of acromegaly, including cardiovascular disease, stroke, diabetes, hypertension, arthropathy, and sleep apnea syndrome, also benefit from biochemical remission following treatment, and management of these complications of the disorder appears to be important in maintaining quality of life as well as assisting with reduction in mortality.