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. 2020 Apr;43(4):529-538.
doi: 10.1007/s40618-019-01138-y. Epub 2019 Nov 18.

Association between biochemical control and comorbidities in patients with acromegaly: an Italian longitudinal retrospective chart review study

A Colao  1 , L F S Grasso  2 , M Di Cera  3 , P Thompson-Leduc  4 , W Y Cheng  4 , H C Cheung  4 , M S Duh  4 , M P Neary  5 , A M Pedroncelli  6 , R Maamari  5 , R Pivonello  2
Affiliations

Association between biochemical control and comorbidities in patients with acromegaly: an Italian longitudinal retrospective chart review study

A Colao et al. J Endocrinol Invest. 2020 Apr.

Abstract

Purpose: Achieving biochemical control (normalization of insulin-like growth factor-1 [IGF-1] and growth hormone [GH]) is a key goal in acromegaly management. However, IGF-1 and GH fluctuate over time. The true potential impact of time-varying biochemical control status on comorbidities is unclear and relies on multiple, longitudinal IGF-1 and GH measurements. This study assessed the association between time-varying biochemical control status and onset of selected comorbidities in patients with acromegaly.

Methods: Medical charts of adults with confirmed acromegaly and ≥ 6 months of follow-up at an Italian endocrinology center were reviewed. Patients were followed from the first diagnosis of acromegaly at the center until loss to follow-up, chart abstraction, or death. Biochemical control status was assessed annually and defined as IGF-1 ≤ the upper limit of normal, or GH ≤ 2.5 µg/L in the few cases where IGF-1 was unavailable. Time-varying Cox models were used to assess the association between biochemical control status and comorbidities.

Results: Among 150 patients, 47% were female, average age at diagnosis was 43.1, and mean length of follow-up was 10.4 years. Biochemical control was significantly associated with a lower hazard of diabetes (HR = 0.36, 95% CI 0.15; 0.83) and cardiovascular system disorders (HR = 0.54, 95% CI 0.31; 0.93), and a higher hazard of certain types of arthropathy (HR = 1.68, 95% CI 1.04; 2.71); associations for other comorbidities did not reach statistical significance.

Conclusion: Results further support the importance of achieving biochemical control, as this may reduce the risk of high-burden conditions, including diabetes and cardiovascular system disorders. The association for arthropathy suggests irreversibility of this impairment. Due to limitations, caution is required when interpreting these results.

Keywords: Acromegaly; Comorbidity; Growth hormone; Insulin-like growth factor I; Pituitary diseases.

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Conflict of interest statement

AC declares the following potential conflict of interest: Novartis, Pfizer, Sandoz. RP declares the following potential conflicts of interest: Novartis, Pfizer, Viropharma-Shire, Ferring, Italfarmaco, Ipsen, IBSA, HRA Pharma. MN, AP, and RM are employees and former employees of Novartis. WYC, PTL, HCC, and MSD are employees of Analysis Group, Inc., a consulting firm that was hired by Novartis for this study.

Figures

Fig. 1
Fig. 1
Study design scheme
See this image and copyright information in PMC

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