Postoperative use of somatostatin analogs and mortality in patients with acromegaly

Mark R Postma; Thalijn Lc Wolters; Gerrit van den Berg; Antonius Eduard van Herwaarden; Ac Muller-Kobold; Wim J Sluiter; Margreet A Wagenmakers; Alfons C M van den Bergh; Bruce H R Wolffenbuttel; Ad Hermus; Romana Netea-Maier; André P van Beek

doi:10.1530/EJE-18-0166

Postoperative use of somatostatin analogs and mortality in patients with acromegaly

Mark R Postma, Thalijn Lc Wolters, Gerrit van den Berg, Antonius Eduard van Herwaarden, Ac Muller-Kobold, Wim J Sluiter, Margreet A Wagenmakers, Alfons C M van den Bergh, Bruce H R Wolffenbuttel, Ad Hermus, Romana Netea-Maier, André P van Beek

Onderzoeksoutput: Article › Academic › peer review

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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.

Originele taal-2	English
Pagina's (van-tot)	1-9
Aantal pagina's	9
Tijdschrift	European Journal of Endocrinology
Volume	180
Nummer van het tijdschrift	1
DOI's	https://doi.org/10.1530/EJE-18-0166
Status	Published - jan.-2019

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Postoperative use of somatostatin analogs and mortality in patients with acromegalyFinal publisher's version, 475 KBLicentie: Taverne

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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. (2019). Postoperative use of somatostatin analogs and mortality in patients with acromegaly. European Journal of Endocrinology, 180(1), 1-9. https://doi.org/10.1530/EJE-18-0166

@article{b7c9b7416d9e43fca2a188cd35752cb0,

title = "Postoperative use of somatostatin analogs and mortality in patients with acromegaly",

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 SDSResults: 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.",

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

author = "Postma, {Mark R} and Wolters, {Thalijn Lc} and {van den Berg}, Gerrit and {van Herwaarden}, {Antonius Eduard} and Ac Muller-Kobold and Sluiter, {Wim J} and Wagenmakers, {Margreet A} and {van den Bergh}, {Alfons C M} and Wolffenbuttel, {Bruce H R} and Ad Hermus and Romana Netea-Maier and {van Beek}, {Andr{\'e} P}",

year = "2019",

month = jan,

doi = "10.1530/EJE-18-0166",

language = "English",

volume = "180",

pages = "1--9",

journal = "European Journal of Endocrinology",

issn = "0804-4643",

publisher = "BIOSCIENTIFICA LTD",

number = "1",

}

Postma, MR, Wolters, TL, van den Berg, G, van Herwaarden, AE, Muller-Kobold, A, Sluiter, WJ, Wagenmakers, MA, van den Bergh, ACM, Wolffenbuttel, BHR, Hermus, A, Netea-Maier, R & van Beek, AP 2019, 'Postoperative use of somatostatin analogs and mortality in patients with acromegaly', European Journal of Endocrinology, vol. 180, nr. 1, blz. 1-9. https://doi.org/10.1530/EJE-18-0166

TY - JOUR

T1 - Postoperative use of somatostatin analogs and mortality in patients with acromegaly

AU - Postma, Mark R

AU - Wolters, Thalijn Lc

AU - van den Berg, Gerrit

AU - van Herwaarden, Antonius Eduard

AU - Muller-Kobold, Ac

AU - Sluiter, Wim J

AU - Wagenmakers, Margreet A

AU - van den Bergh, Alfons C M

AU - Wolffenbuttel, Bruce H R

AU - Hermus, Ad

AU - Netea-Maier, Romana

AU - van Beek, André P

PY - 2019/1

Y1 - 2019/1

N2 - 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 SDSResults: 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.

AB - 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 SDSResults: 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.

KW - QUALITY-OF-LIFE

KW - GROWTH-HORMONE

KW - IGF-I

KW - THERAPY

KW - RADIOTHERAPY

KW - MANAGEMENT

KW - CRITERIA

KW - GH

KW - PREDICTORS

KW - CONSENSUS

U2 - 10.1530/EJE-18-0166

DO - 10.1530/EJE-18-0166

M3 - Article

C2 - 30400068

SN - 0804-4643

VL - 180

SP - 1

EP - 9

JO - European Journal of Endocrinology

JF - European Journal of Endocrinology

IS - 1

ER -

Postoperative use of somatostatin analogs and mortality in patients with acromegaly

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