A paradigm shift in the monitoring of patients with acromegaly: last available growth hormone may overestimate risk
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A paradigm shift in the monitoring of patients with acromegaly : last available growth hormone may overestimate risk. / Sherlock, Mark; Reulen, Raoul C; Aragon-Alonso, Aurora; Ayuk, John; Clayton, Richard N; Sheppard, Michael C; Hawkins, Michael M; Bates, Andrew S; Stewart, Paul M.
In: The Journal of clinical endocrinology and metabolism, Vol. 99, No. 2, 02.2014, p. 478-85.Research output: Contribution to journal › Article › peer-review
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TY - JOUR
T1 - A paradigm shift in the monitoring of patients with acromegaly
T2 - last available growth hormone may overestimate risk
AU - Sherlock, Mark
AU - Reulen, Raoul C
AU - Aragon-Alonso, Aurora
AU - Ayuk, John
AU - Clayton, Richard N
AU - Sheppard, Michael C
AU - Hawkins, Michael M
AU - Bates, Andrew S
AU - Stewart, Paul M
PY - 2014/2
Y1 - 2014/2
N2 - 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.
AB - 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.
KW - Acromegaly
KW - Adult
KW - Aged
KW - Combined Modality Therapy
KW - Female
KW - Human Growth Hormone
KW - Humans
KW - Insulin-Like Growth Factor I
KW - Male
KW - Middle Aged
KW - Predictive Value of Tests
KW - Treatment Outcome
U2 - 10.1210/jc.2013-2450
DO - 10.1210/jc.2013-2450
M3 - Article
C2 - 24243636
VL - 99
SP - 478
EP - 485
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
SN - 0021-972X
IS - 2
ER -