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Decreasing mortality and changes in treatment patterns in patients with acromegaly from a nationwide study
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- Esposito, Daniela (author)
- Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för invärtesmedicin och klinisk nutrition,Institute of Medicine, Department of Internal Medicine and Clinical Nutrition
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- Ragnarsson, Oskar, 1971 (author)
- Gothenburg University,Göteborgs universitet,Institutionen för medicin,Institute of Medicine
- Granfeldt, D. (author)
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- Marlow, T. (author)
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- (creator_code:org_t)
- 2018
- 2018
- English.
- In: European Journal of Endocrinology. - 0804-4643 .- 1479-683X. ; 178:5, s. 459-469
- Journal article (peer-reviewed)
Abstract
Subject headings
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- Context: New therapeutic strategies have developed for the management of acromegaly over recent decades. Whether this has improved mortality has not been fully elucidated. Objective: The primary aim was to investigate mortality in a nationwide unselected cohort of patients with acromegaly. Secondary analyses included time trends in mortality and treatment patterns. Design: A total of 1089 patients with acromegaly were identified in Swedish National Health Registries between 1987 and 2013. To analyse time trends, the cohort was divided into three periods (1987–1995, 1996–2004 and 2005–2013) based on the year of diagnosis. Main outcome measures: Using the Swedish population as reference, standardized mortality ratios (SMRs) were calculated with 95% confidence intervals (CIs). Results: Overall SMR was 2.79 (95% CI: 2.43–3.15) with 232 observed and 83 expected deaths. Mortality was mainly related to circulatory diseases (SMR: 2.95, 95% CI: 2.35–3.55), including ischemic heart disease (2.00, 1.35–2.66) and cerebrovascular disease (3.99, 2.42–5.55) and malignancy (1.76, 1.27–2.26). Mortality decreased over time, with an SMR of 3.45 (2.87–4.02) and 1.86 (1.04–2.67) during the first and last time period, respectively (P=.015). During the same time periods, the frequency of pituitary surgery increased from 58% to 72% (P<0.001) and the prevalence of hypopituitarism decreased from 41% to 23% (P<0.001). Conclusions: Excess mortality was found in this nationwide cohort of patients with acromegaly, mainly related to circulatory and malignant diseases. Although still high, mortality significantly declined over time. This could be explained by the more frequent use of pituitary surgery, decreased prevalence of hypopituitarism and the availability of new medical treatment options. © 2018 European Society of Endocrinology Printed in Great Britain.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Endokrinologi och diabetes (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Endocrinology and Diabetes (hsv//eng)
Keyword
- human growth hormone
- acromegaly
- adenoma
- adult
- aged
- clinical practice
- cohort analysis
- female
- follow up
- growth hormone secreting adenoma
- health care survey
- human
- hypopituitarism
- male
- middle aged
- mortality
- multimodality cancer therapy
- pathophysiology
- population dynamics
- prevalence
- register
- secretion (process)
- sex factor
- Sweden
- trends
- Cohort Studies
- Combined Modality Therapy
- Follow-Up Studies
- Growth Hormone-Secreting Pituitary Adenoma
- Health Care Surveys
- Health Transition
- Humans
- Practice Patterns
- Physicians'
- Registries
- Sex Factors
Publication and Content Type
- ref (subject category)
- art (subject category)
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