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Postoperative use of somatostatin analogs and mortality in patients with acromegaly
- Source :
- European Journal of Endocrinology, 180(1), 1-9. Bioscientifica Ltd, European Journal of Endocrinology, 180, 1-9, European Journal of Endocrinology, 180(1), 1-9. BIOSCIENTIFICA LTD, European Journal of Endocrinology, 180, 1, pp. 1-9
- Publication Year :
- 2019
-
Abstract
- Objective To assess the effect of somatostatin analogs (SSAs) on mortality in relation to disease control of acromegaly after pituitary surgery. Design A retrospective study in two large tertiary referral centers in The Netherlands. Methods Overall, 319 patients with acromegaly in whom pituitary surgery was performed as primary therapy between January 1980 and July 2017 were included. Postoperative treatment with SSA was prescribed to 174 (55%) patients because of persistent or recurrent disease. Disease control at last visit was assessed by IGF1 standard deviation score (SDS). Adequate disease control was defined as IGF1 SDS ≤2. Univariate determinants of mortality and standardized mortality ratios (SMRs) were calculated for groups with and without SSA at any moment postoperatively and at last visit. Results In total, 27 deaths were observed. In univariate analysis, determinants of mortality were inadequate disease control (relative risk (RR): 3.41, P = 0.005), surgery by craniotomy (RR: 3.53, P = 0.013) and glucocorticoid substitution (RR: 2.11, P = 0.047). There was a strong trend toward increased mortality for patients who used SSA (RR: 2.01, P = 0.067) and/or dopamine agonists (RR: 2.54, P = 0.052) at last visit. The SMR of patients with adequate disease control who used SSA at any moment postoperatively (1.07, P = 0.785) and at last visit (1.19; P = 0.600) was not increased. Insufficiently controlled patients had a significantly raised SMR (3.92, P = 0.006). Conclusions Postoperative use of SSA is not associated with increased mortality in patients with acromegaly who attain adequate disease control. In contrast, inadequate disease control, primary surgery by craniotomy and glucocorticoid substitution are associated with increased mortality.
- Subjects :
- Male
Endocrinology, Diabetes and Metabolism
medicine.medical_treatment
Vascular damage Radboud Institute for Health Sciences [Radboudumc 16]
THERAPY
0302 clinical medicine
Endocrinology
Quality of life
QUALITY-OF-LIFE
CRITERIA
Postoperative Period
PREDICTORS
Craniotomy
Univariate analysis
General Medicine
Middle Aged
Combined Modality Therapy
Women's cancers Radboud Institute for Health Sciences [Radboudumc 17]
IGF-I
GH
Survival Rate
030220 oncology & carcinogenesis
Pituitary Gland
Female
GROWTH-HORMONE
Somatostatin
RADIOTHERAPY
Adenoma
Adult
medicine.medical_specialty
030209 endocrinology & metabolism
Rare cancers Radboud Institute for Molecular Life Sciences [Radboudumc 9]
03 medical and health sciences
All institutes and research themes of the Radboud University Medical Center
Internal medicine
Acromegaly
MANAGEMENT
medicine
Humans
Pituitary Neoplasms
Survival rate
Retrospective Studies
business.industry
Retrospective cohort study
medicine.disease
Radiation therapy
Relative risk
CONSENSUS
business
Subjects
Details
- ISSN :
- 08044643
- Volume :
- 180
- Database :
- OpenAIRE
- Journal :
- European Journal of Endocrinology
- Accession number :
- edsair.doi.dedup.....d59dd8329bc0a055cf4e379b17bb0329