Higher Mortality in Acromegaly Mainly Attributed to Cardiovascular, Respiratory Diseases

After careful consideration, the Endocrine Society canceled its annual meeting (ENDO 2020), which was set to take place in San Francisco, California, from March 28 to 31, 2020, because of concerns regarding coronavirus disease 2019 (COVID-19). Research findings that were scheduled to be presented at the meeting have been published in a supplemental issue of the Journal of the Endocrine Society. The society is hosting ENDO Online, a complimentary virtual event featuring on-demand and live programming, from June 8 to 22, 2020, to provide a platform for continued learning and research exhibition. For more information, visit the Endocrine Society’s website.

Acromegaly is associated with an increased risk for mortality from vascular and respiratory disease, according to research intended to be presented at the annual meeting of the Endocrine Society (ENDO 2020).

Researchers sought to determine mortality rates in patients with acromegaly from vascular, respiratory, and malignant diseases, and whether suppressing posttreatment growth hormone (GH) levels to <1 ng/mL would improve survival compared with GH levels between 1 and 2.5 ng/mL.

A total of 1845 cases (31,768 person-years) from the UK Acromegaly database were included. Researchers determined population mortality rates between 1970 and 2016 (the years included from the database), as well as standardized mortality rates (SMRs) for vascular, respiratory, and malignant diseases, and whether they were associated with age at diagnosis, disease duration, and posttreatment or mean GH levels.

The overall mortality rate was higher than expected (556 observed vs 412.74 expected; SMR, 1.35 [95% CI, 1.24-1.46]; P <.001). Cardiovascular, cerebrovascular, and respiratory disease-related deaths were all increased (SMRs, 1.38 [95% CI, 1.16-1.63; P <.0001], 1.49 [95% CI, 1.10-1.97; P <.006], and 1.55 [95% CI, 1.22-1.93; P <.001], respectively). However, researchers did not find an increase in malignancy-related deaths (0.94; 95% CI, 0.78-1.11; P =.786). More specifically, there was no increase in mortality related to breast, lung, or colon cancers.

In addition, researchers did not find a relationship between age at acromegaly diagnosis and mortality rate, but there was a declining relationship between the duration of acromegaly and standardized all-cause mortality rate (<5 years: SMR, 6.02 [95% CI, 4.59-7.75]; 5-10 years: SMR, 2.42 [95% CI, 1.9-3.03]; >10 years: SMR, 1.13 [95% CI, 1.03-1.25]; P <.001 for all).

All-cause mortality rates were reduced by lowering posttreatment GH levels to <2.5 ng/mL (SMR, 1.15; 95% CI, 1.03-1.28), to between 2.5 and 9.9 ng/mL (SMR, 1.73; 95% CI, 1.47-.2.02), and to ≥10 ng/mL (SMR, 2.27; 95% CI, 1.72-2.95; P <.001 for all). Lowering posttreatment GH levels to <1 ng/mL seemed to have an additional positive effect for all-cause standardized mortality (SMR, 1.03; 95% CI, 0.89-1.18). A similar relationship was seen in cardiovascular, respiratory, and malignant disease-specific mortality, but not in cerebrovascular disease.

The researchers concluded that acromegaly is associated with an increased risk for death from vascular and respiratory disease, but not malignant disease. “The highest risk is within the first 5 years following diagnosis and the risk is abrogated by lowering GH levels to <1.0 ng/ml,” they wrote.

Reference

Orme SM, McNally R, Peter J, et al. Increased mortality in acromegaly is mainly due to vascular and respiratory disease and is normalized by control of growth hormone hypersecretion. J Endocr Soc. 2020;4(suppl 1):SUN-LB48.

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