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Department of Internal Medicine (R.K.-M.), Jorvi Hospital, FIN-02740 Espoo, Finland; Division of Endocrinology (T.S., M.J.V.), Department of Medicine, and Department of Clinical Chemistry (H.M., U.-H.S.), Helsinki University Central Hospital, FIN-00029 Helsinki, Finland; National Public Health Institute (A.R.), FIN-00300 Helsinki, Finland; Department of Medicine (L.N., E.V.), Kuopio University Hospital, FIN-70211 Kuopio, Finland; Department of Statistics (E.L.), University of Turku, FIN-20014 Turku, Finland; Department of Internal Medicine (T.E., P.S.), Oulu University Hospital, FIN-90221 Oulu, Finland; Department of Internal Medicine (P.J., J.S.), Tampere University Hospital, FIN-33014 Tampere, Finland; and Department of Internal Medicine (H.L., P.N., J.V.), Turku University Central Hospital, FIN-20520 Turku, Finland
Address all correspondence and requests for reprints to: Ritva Kauppinen-Mäkelin, M.D., Ph.D., Department of Internal Medicine, Jorvi Hospital, FIN-02740 Espoo, Finland. E-mail: ritva.kauppinen-makelin{at}hus.fi.
Context: Increased mortality in acromegaly has been confined to those with posttreatment basal GH of 2.5 µg/liter or greater, but the impact of IGF-I and pituitary radiotherapy on mortality has remained controversial.
Objective: The purpose of this nationwide survey was to examine the all-cause mortality of patients with acromegaly and evaluate the impact of treatment outcome and mode of treatment on survival.
Design, Setting, and Patients: All-cause mortality of all patients with acromegaly diagnosed during January 1980 and December 1999 in the five university hospitals of Finland was followed up by the end of 2002 (12.5 ± 5.6 yr) and compared with that of the general population by using age- and gender-adjusted standardized mortality ratios (SMRs). Logistic regression analysis was used to investigate factors related to mortality within the survey population.
Main Outcome Measure: Mortality was the main outcome measure.
Results: Of the 334 patients, 56 (16.8%) had died during follow-up. SMR of the patients was 1.16 [confidence interval (CI) 0.85–1.54, not significant (NS)]. However, patients with basal serum GH concentration 2.5 µg/liter or greater (SMR 1.63, CI 1.10–2.35, P < 0.001) measured 5.2 ± 4.4 yr after the initial treatment, and those irradiated (SMR 1.69, CI 1.05–2.58, P < 0.001) showed excess mortality. In a multivariate model, the effect of radiotherapy was of borderline significance only (P = 0.083). Posttreatment IGF-I levels, available for 72.2% of the patients, did not have impact on mortality.
Conclusions: The posttreatment basal GH concentration less than 2.5 µg/liter in acromegalic patients is associated with a normal lifespan. Excess mortality is confined to poorly controlled patients and possibly those who have received conventional radiotherapy.
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