Endocrinology Service/Experimental Endocrinology Unit (M.M., B.G., G.V., C.R., A.L.E.d.l.M., E.S., P.J., P.R., V.M.) and Department of Neurosurgery (B.L.-F., G.G.), Hospital de Especialidades, Centro Medico Nacional S.XXI, Instituto Mexicano del Seguro Social, Mexico City 11560, Mexico; and Neurological Center (M.M., B.G., C.R., G.G.), ABC Medical Center, Mexico City 05300, Mexico.
J Clin Endocrinol Metab. 2014 Dec;99(12):4438-46. doi: 10.1210/jc.2014-2670.
Acromegaly is usually due to the excessive secretion of GH by a pituitary adenoma. It is frequently accompanied by comorbidities that compromise quality of life and results in elevated mortality rates.
To evaluate mortality and morbidity in patients with acromegaly receiving multimodal care.
Tertiary care center.
DESIGN, PATIENTS, AND METHODS: Retrospective evaluation of 442 patients (65.4% women; mean age, 43.5 ± 13.1 y) followed for a median of 6 years (interquartile range [IQR], 3-10).
Twenty-two patients died during the study period (4.9%), representing a total standardized mortality ratio (SMR) of 0.72 (95% confidence interval [CI], 0.41-1.03). Standardized mortality ratios were 1.5 and 0.44 for patients whose last GH was above and below 2.5 ng/mL, respectively; 1.17 and 0.16 for those whose last GH was above and below 1 ng/mL, respectively; and 0.94 and 0.46 for those whose last IGF-1 was above and below 1.2 times the upper limit of normal (ULN), respectively. The prevalence of diabetes mellitus, hypertension, heart disease, and cancer was 30%, 35%, 8%, and 4.7%, respectively. The most common cause of death was cancer. On multivariate analysis, diabetes, heart disease, and cancer were related to a baseline GH > 10 ng/mL; the presence of cancer and the last IGF-1 were significant predictors of mortality. Survival decreased as the latest GH levels increased from < 1 ng/mL to > 5 ng/mL and as IGF-1 increased from < 1.2 to > 2 times the ULN.
Mortality in acromegaly can be successfully reduced, provided patients are treated using a multimodal approach with careful management of comorbidities.
肢端肥大症通常是由于垂体腺瘤过度分泌 GH 所致。它常伴有合并症，这些合并症会降低生活质量，并导致死亡率升高。
评估接受多模式治疗的肢端肥大症患者的死亡率和发病率。
三级保健中心。
设计、患者和方法：回顾性评估了 442 名患者（65.4%为女性；平均年龄为 43.5±13.1 岁），中位随访时间为 6 年（四分位距 [IQR]，3-10）。
在研究期间，有 22 名患者死亡（4.9%），总标准化死亡率（SMR）为 0.72（95%置信区间 [CI]，0.41-1.03）。最后一次 GH 高于和低于 2.5ng/mL 的患者的 SMR 分别为 1.5 和 0.44；最后一次 GH 高于和低于 1ng/mL 的患者的 SMR 分别为 1.17 和 0.16；最后一次 IGF-1 高于和低于正常值上限（ULN）1.2 倍的患者的 SMR 分别为 0.94 和 0.46。糖尿病、高血压、心脏病和癌症的患病率分别为 30%、35%、8%和 4.7%。最常见的死亡原因是癌症。多变量分析显示，基线 GH＞10ng/mL 与糖尿病、心脏病和癌症有关；癌症的存在和最后一次 IGF-1 是死亡的显著预测因素。随着最新 GH 水平从＜1ng/mL 升高至＞5ng/mL 和 IGF-1 从＜1.2 倍 ULN 升高至＞2 倍 ULN，生存率下降。
如果采用多模式方法治疗，且合并症得到精心管理，则肢端肥大症的死亡率可以成功降低。
