A Nationwide Survey of Mortality in Acromegaly

Context: Increased mortality in acromegaly has been confined to those with posttreatment basal GH of 2.5 μg/liter or greater, but the impact of IGF-I and pituitary radiotherapy on mortality has remained controversial. Objective: The purpose of this nationwide survey was to examine the all-cause mortality of patients with acromegaly and evaluate the impact of treatment outcome and mode of treatment on survival. Design, Setting, and Patients: All-cause mortality of all patients with acromegaly diagnosed during January 1980 and December 1999 in the five university hospitals of Finland was followed up by the end of 2002 (12.5 ± 5.6 yr) and compared with that of the general population by using age- and gender-adjusted standardized mortality ratios (SMRs). Logistic regression analysis was used to investigate factors related to mortality within the survey population. Main Outcome Measure: Mortality was the main outcome measure. Results: Of the 334 patients, 56 (16.8%) had died during follow-up. SMR of the patients was 1.16 [confidence interval (CI) 0.85–1.54, not significant (NS)]. However, patients with basal serum GH concentration 2.5 μg/liter or greater (SMR 1.63, CI 1.10–2.35, P < 0.001) measured 5.2 ± 4.4 yr after the initial treatment, and those irradiated (SMR 1.69, CI 1.05–2.58, P < 0.001) showed excess mortality. In a multivariate model, the effect of radiotherapy was of borderline significance only (P = 0.083). Posttreatment IGF-I levels, available for 72.2% of the patients, did not have impact on mortality. Conclusions: The posttreatment basal GH concentration less than 2.5 μg/liter in acromegalic patients is associated with a normal lifespan. Excess mortality is confined to poorly controlled patients and possibly those who have received conventional radiotherapy.