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

• Published in: European journal of endocrinology Vol. 186; no. 3; pp. 329 - 339
• Main Authors: Arnardóttir, Steinunn, Järås, Jacob, Burman, Pia, Berinder, Katarina, Dahlqvist, Per, Erfurth, Eva Marie, Höybye, Charlotte, Larsson, Karin, Ragnarsson, Oskar, Ekman, Bertil, Edén Engström, Britt
• Format: Journal Article
• Language: English
• Published: England Bioscientifica Ltd 2022
• Subjects: acromegaly; Acromegaly - metabolism; Acromegaly - therapy; adenoma; Adenoma - complications; Adenoma - metabolism; Adenoma - pathology; Adenoma - therapy; Adjuvant; adjuvant chemotherapy; adjuvant radiotherapy; Adult; Aged; Antineoplastic Agents; Antineoplastic Agents, Hormonal - therapeutic use; antineoplastic hormone agonists and antagonists; Cause of Death; Chemotherapy; Chemotherapy, Adjuvant; Clinical Medicine; Clinical Study; complication; Endocrinology and Diabetes; Endokrinologi och diabetes; Female; growth hormone secreting adenoma; Growth Hormone-Secreting Pituitary Adenoma; Growth Hormone-Secreting Pituitary Adenoma - complications; Growth Hormone-Secreting Pituitary Adenoma - metabolism; Growth Hormone-Secreting Pituitary Adenoma - pathology; Growth Hormone-Secreting Pituitary Adenoma - therapy; Hormonal; human; Humans; hypopituitarism; Hypopituitarism - etiology; Hypopituitarism - metabolism; Insulin-Like Growth Factor I; Insulin-Like Growth Factor I - metabolism; Klinisk medicin; Linear Models; Male; Medical and Health Sciences; Medicin och hälsovetenskap; metabolism; Middle Aged; Mortality; neurosurgery; Neurosurgical Procedures; pathology; pathophysiology; proportional hazards model; Proportional Hazards Models; Radiosurgery; Radiotherapy; Radiotherapy, Adjuvant; register; Registries; somatomedin C; somatostatin; Somatostatin - analogs & derivatives; statistical model; Sweden; Tumor Burden; tumor volume; Vision Disorders; Vision Disorders - etiology; Vision Disorders - physiopathology; visual disorder; visual field; Visual Fields; Sweden
• ISSN: 0804-4643; 1479-683X; 1479-683X
• DOI: 10.1530/EJE-21-0729

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.