Long-term outcomes of patients with acromegaly: a report from the Swedish Pituitary Register

• Objective: To describe the treatment and long-term outcomes of patients with acromegaly from all healthcare regions in Sweden. Design and methods: Analysis of prospectively reported data from the Swedish Pituitary Register of 698 patients (51% females) with acromegaly diagnosed from 1991 to 2011. The latest clinical follow-up date was December 2012, while mortality data were collected for 28.5 years until June 2019. Results: The annual incidence was 3.7/million; 71% of patients had a macroadenoma, 18% had visual field defects, and 25% had at least one pituitary hormone deficiency. Eighty-two percent had pituitary surgery, 10% radiotherapy, and 39% medical treatment. At the 5- and 10-year follow-ups, insulin-like growth factor 1 levels were within the reference range in 69 and 78% of patients, respectively. In linear regression, the proportion of patients with biochemical control including adjuvant therapy at 10 years follow-up increased over time by 1.23% per year. The standardized mortality ratio (SMR) (95% CI) for all patients was 1.29 (1.11-1.49). For patients with biochemical control at the latest follow-up, SMR was not increased, neither among patients diagnosed between 1991 and 2000, SMR: 1.06 (0.85-1.33) nor between 2001 and2011, SMR: 0.87 (0.61-1.24). In contrast, non-controlled patients at the latest follow-up from both decades had elevated SMR, 1.90 (1.33-2.72) and 1.98 (1.24-3.14), respectively. Conclusions: The proportion of patients with biochemical control increased over time. Patients with biochemically controlled acromegaly have normal life expectancy, while non-controlled patients still have increased mortality. The high rate of macroadenomas and unchanged age at diagnosis illustrates the need for improvements in the management of patients with acromegaly.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Endokrinologi och diabetes (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Endocrinology and Diabetes (hsv//eng)

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kirurgi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Surgery (hsv//eng)

Nyckelord

antineoplastic hormone agonists and antagonists

somatomedin C

somatostatin

acromegaly

adenoma

adjuvant chemotherapy

adjuvant radiotherapy

adult

aged

cause of death

complication

female

growth hormone secreting adenoma

human

hypopituitarism

male

metabolism

middle aged

mortality

neurosurgery

pathology

pathophysiology

proportional hazards model

radiosurgery

radiotherapy

register

statistical model

Sweden

tumor volume

visual disorder

visual field

Antineoplastic Agents

Hormonal

Chemotherapy

Adjuvant

Growth Hormone-Secreting Pituitary Adenoma

Humans

Insulin-Like Growth Factor I

Linear Models

Neurosurgical Procedures

Proportional Hazards Models

Radiotherapy

Adjuvant

Registries

Tumor Burden

Vision Disorders

Visual Fields

Publikations- och innehållstyp

ref (ämneskategori)

art (ämneskategori)