Mortality in acromegaly: a 20-year follow-up study

Abstract

Objective: It is unclear whether mortality still is increased in acromegaly and whether there are gender-related differences. We dynamically assessed outcome during long-term follow-up in our nationwide cohort. Patients and methods: We studied standardized mortality ratios (SMRs) relative to the general population and causes of death in acromegaly ( n =333) compared with age- and gender-matched controls ( n =4995). Results: During 20 (0–33) years follow-up, 113 (34%) patients ( n =333, 52% women) and 1334 (27%) controls ( n =4995) died ( P =0.004). SMR (1.9, 95% CI: 1.53–2.34, P <0.001) and all-cause mortality (OR 1.6, 95% CI: 1.2–2.2, P <0.001) were increased in acromegaly. Overall distribution of causes of death ( P <0.001) differed between patients and controls but not cardiovascular (34% vs 33%) or cancer deaths (27% vs 27%). In acromegaly, but not in controls, causes of deaths shifted from 44% cardiovascular and 28% cancer deaths during the first decade, to 23% cardiovascular and 35% cancer deaths during the next two decades. In acromegaly, cancer deaths were mostly attributed to pancreatic adenocarcinoma ( n =5), breast ( n =4), lung ( n =3) and colon ( n =3) carcinoma. In acromegaly, men were younger than women at diagnosis (median 44.5 vs 50 years, P <0.001) and death (67 vs 76 years, P =0.0015). Compared with controls, women (36% vs 25%, P <0.01), but not men (31% vs 28%, P =0.44), had increased mortality. Conclusions: In acromegaly, men are younger at diagnosis and death than women. Compared with controls, mortality is increased during 20 years of follow-up, especially in women. Causes of deaths shift from predominantly cardiovascular to cancer deaths.