Could different treatment approaches in acromegaly influence life expectancy? A comparative study between Bulgaria and Campania (Italy)
| Autor: | Rosario Pivonello, Annamaria Colao, Krasimir Kalinov, E. Nachev, Silvia Vandeva, Ludovica Francesca Stella Grasso, Sabina Zacharieva, Renata S Auriemma |
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| Přispěvatelé: | Colao, Annamaria, Vandeva, S, Pivonello, Rosario, Grasso, LUDOVICA FRANCESCA STELLA, Nachev, E, Auriemma, RENATA SIMONA, Kalinov, K, Zacharieva, S. |
| Rok vydání: | 2014 |
| Předmět: |
Adult
Male Pediatrics medicine.medical_specialty Endocrinology Diabetes and Metabolism Population Comorbidity Cohort Studies Endocrinology Life Expectancy Acromegaly Medicine Humans Insulin-Like Growth Factor I education Bulgaria Retrospective Studies education.field_of_study business.industry Human Growth Hormone Mortality rate Retrospective cohort study General Medicine Receptors Somatotropin Middle Aged medicine.disease Standardized mortality ratio Treatment Outcome Italy Cohort Dopamine Agonists Life expectancy Female business Somatostatin Cohort study |
| Zdroj: | European journal of endocrinology. 171(2) |
| ISSN: | 1479-683X |
| Popis: | BackgroundMortality in acromegaly strictly depends on optimal control of GH and IGF1 levels. Modern medical therapy with somatostatin analogs (SSAs) and GH receptor antagonists (GHRAs) is not available in many countries due to funding restrictions. This retrospective, comparative, cohort study investigated the impact of different treatment modalities on disease control (GH and IGF1) and mortality in acromegaly patients.MethodsTwo cohorts of patients with acromegaly from Bulgaria (n=407) and Campania, Italy (n=220), were compared, and mortality rates were evaluated during a 10-year period (1999–2008).ResultsThe major difference in treatment approach between cohorts was the higher utilization of SSAs and GHRAs in Italy, leading to a decreased requirement for radiotherapy. Significantly more Italian than Bulgarian patients had achieved disease control (50.1 vs 39.1%, P=0.005) at the last follow-up. Compared with the general population, the Bulgarian cohort had a decreased life expectancy with a standardized mortality ratio (SMR) of 2.0 (95% CI 1.54–2.47) that was restored to normal in patients with disease control – SMR 1.25 (95% CI 0.68–1.81). Irradiated patients had a higher cerebrovascular mortality – SMR 7.15 (95% CI 2.92–11.37). Internal analysis revealed an independent role of age at diagnosis and last GH value on all-cause mortality and radiotherapy on cerebrovascular mortality. Normal survival rates were observed in the Italian cohort: SMR 0.66 (95% CI 0.27–1.36).ConclusionsSuboptimal biochemical control was associated with a higher mortality in the Bulgarian cohort. Modern treatment options that induce a strict biochemical control and reduce the necessity of radiotherapy might influence the life expectancy. Other factors, possibly management of comorbidities, could contribute to survival rates. |
| Databáze: | OpenAIRE |
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