Insulin-like growth factor-1, growth hormone and disease outcomes in acromegaly: a population study.
Thomas, Melissa Berni, Ellen Jenkins-Jones, Sara Wensley, Sarah Poole, Chris D Currie, Craig J Brownrigg, Jack Ayuk, John Rees, D Aled
Thomas, Melissa
Berni, Ellen
Jenkins-Jones, Sara
Wensley, Sarah
Poole, Chris D
Currie, Craig J
Brownrigg, Jack
Ayuk, John
Rees, D Aled
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2021-04-04
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Abstract
Context: A lack of consensus remains about the relative importance of insulin-like growth factor-1 (IGF-1) and growth hormone (GH) in predicting adverse outcomes in patients with acromegaly.
Objective: To describe the differing association between IGF-1 and GH and major disease outcomes in acromegaly.
Design: Retrospective cohort study.
Patients: United Kingdom National Health Service patients with acromegaly who had an IGF-1 and/or a GH measurement recorded following diagnosis, prior to December 2019.
Measurements: A composite endpoint including all-cause mortality (ACM), type 2 diabetes (DM), major adverse cardiovascular events (MACE) or cancer was the primary outcome. These outcomes were also analysed individually. Follow-up period was capped at 5 years.
Results: A maximum of 417 cases and 332 cases were eligible for the IGF-1 and GH analyses, respectively, comprising 1041.5 and 938.9 years of follow-up. There was a direct association between increased IGF-1 concentration and adjusted event risk for the composite endpoint (hazard ratio [HR] = 1.2; 95% confidence interval [CI] = 1.02-1.5); in GH, the HR was 1.1 (1.0-1.2). For the individual endpoints in relation to IGF-1 level, the HRs were ACM (1.2; 0.93-1.5), MACE (1.2; 0.64-2.1), DM (1.53; 1.09-2.2) and cancer (1.3; 0.95-1.7). For GH, the HRs were ACM (1.1; 0.97-1.2), MACE (0.99; 0.73-1.3), DM (1.1; 0.99-1.2) and cancer (0.90; 0.66-1.2).
Conclusions: In this contemporary data set with extended follow-up, IGF-1 and GH concentrations showed an association with major adverse outcomes from acromegaly.
Citation
Thomas M, Berni E, Jenkins-Jones S, Wensley S, Poole CD, Currie CJ, Brownrigg J, Ayuk J, Rees DA. Insulin-like growth factor-1, growth hormone and disease outcomes in acromegaly: A population study. Clin Endocrinol (Oxf). 2021 Jul;95(1):143-152. doi: 10.1111/cen.14468. Epub 2021 Apr 4
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