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A paradigm shift in the monitoring of patients with acromegaly: last available growth hormone may overestimate risk.

Sherlock, Mark and Reulen, Raoul C and Aragon-Alonso, Aurora and Ayuk, John and Clayton, Richard N and Sheppard, Michael C and Hawkins, Michael M and Bates, Andrew S and Stewart, Paul M (2014) A paradigm shift in the monitoring of patients with acromegaly: last available growth hormone may overestimate risk. The Journal of clinical endocrinology and metabolism, 99 (2). pp. 478-85. ISSN 1945-7197. Available to HEFT Athens users via www.evidence.nhs.uk

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Official URL: http://press.endocrine.org/doi/abs/10.1210/jc.2013...

Abstract

CONTEXT

Acromegaly is associated with reduced life expectancy, which has been reported to be normalized if treatment is successful in controlling GH/IGF-I levels.

OBJECTIVE

Most previous studies have invariably used the last available GH/IGF-I, which may be biased as it only assesses exposure at a single point in time. We compared the last available GH/IGF-I analysis to a "time-dependent" and cumulative method, during follow-up to assess risk of mortality in the West Midlands Acromegaly study (n = 501).

RESULTS

Using the last available GH, there was a statistically significant increase in mortality comparing groups as low as GH ≤ 1 μg/L vs >1 μg/L (relative risks [RR] 1.8, P = .03). This was not the case when using the "time-dependent method," where only comparisons of GH values of GH ≤5 μg/L vs >5 μg/L were suggestive of being associated with an increased risk of mortality (RR = 1.5, P = .08). When the time-dependent GH method of analysis was used, the RR of mortality at each level was lower and the associated P value was less significant. Irrespective of using the last available or time-dependent method, when IGF-I was divided into levels according to quartile or arbitrary cutoffs, there was no significant increase in mortality with higher levels.

CONCLUSIONS

This study emphasizes the potential bias of using the latest available GH/IGF-I levels to predict mortality. Our study again highlights the limitations of IGF-I in predicting mortality.

Item Type: Article
Additional Information: Available to HEFT Athens users via www.evidence.nhs.uk
Subjects: WK Endocrine system. Endocrinology
Divisions: Ambulatory Care > Diabetes
Related URLs:
Depositing User: Sophie Rollason
Date Deposited: 02 Jul 2014 15:24
Last Modified: 02 Jul 2014 15:24
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/467

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