Esposito D, et al. - The mortality rate was determined in a nationwide unselected cohort of patients with acromegaly. In addition, time trends were analyzed with respect to mortality and treatment patterns. This nationwide cohort showed excess mortality, mainly related to circulatory and malignant diseases. Mortality has significantly declined over time, although still high. The more frequent use of pituitary surgery, decreased prevalence of hypopituitarism, and the availability of new medical treatment options could explain the finding.

Methods

• 1,089 patients with acromegaly were identified in Swedish National Health Registries between 1987-2013.
• The cohort was divided into three periods (1987-1995, 1996-2004, and 2005-2013) based on year of diagnosis to analyse time trends.
• Standardized mortality ratios (SMRs) were calculated with 95% confidence intervals (Cis) using the Swedish population as reference.

Results

• Researchers noted an overall SMR of 2.79 (95% CI 2.43-3.15) with 232 observed and 83 expected deaths.
• Mortality was observed mainly in association with circulatory diseases (SMR 2.95, 95% CI 2.35-3.55), including ischemic heart disease (2.00, 1.35-2.66), cerebrovascular disease (3.99, 2.42-5.55), and malignancy (1.76, 1.27-2.26).
• A decrease in mortality was evident with time, with a SMR of 3.45 (2.87-4.02) and 1.86 (1.04-2.67) during the first and last time periods, respectively (P=.015).
• The frequency of pituitary surgery increased from 58% to 72% (P<.001) and the prevalence of hypopituitarism decreased from 41% to 23% (P<.001) during the same time periods.