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Department of Endocrinology (S.M.O., P.E.B.), The General Infirmary at Leeds, The Leukemia Research Fund (R.J.Q.M., R.A.C.), Center for Clinical Epidemiology, University of Leeds, Leeds, United Kingdom
Address all correspondence and requests for reprints to: Dr. S. M. Orme, Department of Endocrinology, The General Infirmary at Leeds, Great George Street, Leeds, United Kingdom LS1 3EX.
Patients with acromegaly have a reduced life expectancy, with the accepted causes for premature death being vascular and respiratory disease. Increased mortality from malignant disease has also been reported. We, therefore, performed a multicenter retrospective cohort study of 1362 patients with acromegaly and investigated the relationships of mortality and cancer incidence with GH levels, duration of disease, and age at diagnosis.
The overall cancer incidence rate [standardized incidence ratio, 0.76; 95% confidence interval (CI), 0.60–0.95] was lower than that in the general population of the United Kingdom, and there was no significant increase in site-specific cancer incidence rates. The overall cancer mortality rate was not increased, but the colon cancer mortality rate (standardized mortality ratio, 2.47; 95% CI, 1.31–4.22) was higher than expected. Mortality rates due to colon cancer, all malignant disease, cardiovascular disease and overall mortality were increased with higher posttreatment GH levels (P for trends, <0.02, <0.05, <0.02, and <0.0001). The overall mortality rate in patients with acromegaly with posttreatment GH levels less than 2.5 ng/mL (5 mU/L) was comparable to that in the general population of the United Kingdom (standardized mortality ratio, 1.10; 95% CI, 0.89–1.35).
We conclude that high posttreatment GH levels are associated with an increased overall mortality rate and increased mortality rates due to colon cancer, cardiovascular disease, and all malignant disease. Posttreatment GH levels less than 2.5 ng/mL (5 mU/L) result in an overall mortality rate similar to that in the general population.
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K. S.-L. Lam, A. Xu, K. C.-B. Tan, L.-C. Wong, S.-C. Tiu, and S. Tam Serum Adiponectin Is Reduced in Acromegaly and Normalized after Correction of Growth Hormone Excess J. Clin. Endocrinol. Metab., November 1, 2004; 89(11): 5448 - 5453. [Abstract] [Full Text] [PDF]
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A. Colao, L. Spinelli, P. Marzullo, R. Pivonello, M. Petretta, C. Di Somma, G. Vitale, D. Bonaduce, and G. Lombardi High Prevalence of Cardiac Valve Disease in Acromegaly: An Observational, Analytical, Case-Control Study J. Clin. Endocrinol. Metab., July 1, 2003; 88(7): 3196 - 3201. [Abstract] [Full Text] [PDF]
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R. N. Clayton Cardiovascular Function in Acromegaly Endocr. Rev., June 1, 2003; 24(3): 272 - 277. [Abstract] [Full Text] [PDF]
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J. C. Smith, H. Lane, N. Davies, L. M. Evans, J. Cockcroft, M. F. Scanlon, and J. S. Davies The Effects of Depot Long-Acting Somatostatin Analog on Central Aortic Pressure and Arterial Stiffness in Acromegaly J. Clin. Endocrinol. Metab., June 1, 2003; 88(6): 2556 - 2561. [Abstract] [Full Text] [PDF]
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