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Postoperative use of somatostatin analogs and mortality in patients with acromegaly

Postma, M. R., Wolters, T. L., van den Berg, G., van Herwaarden, A. E., Muller-Kobold, A., Sluiter, W. J., Wagenmakers, M. A., van den Bergh, A. C. M., Wolffenbuttel, B. H. R., Hermus, A., Netea-Maier, R. & van Beek, A. P., Jan-2019, In : European Journal of Endocrinology. 180, 1, p. 1-9 9 p.

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  • Postoperative use of somatostatin analogs and mortality in patients with acromegaly

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DOI

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

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.

Original languageEnglish
Pages (from-to)1-9
Number of pages9
JournalEuropean Journal of Endocrinology
Volume180
Issue number1
Early online dateJan-2019
Publication statusPublished - Jan-2019

    Keywords

  • QUALITY-OF-LIFE, GROWTH-HORMONE, IGF-I, THERAPY, RADIOTHERAPY, MANAGEMENT, CRITERIA, GH, PREDICTORS, CONSENSUS

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