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dc.contributor.authorEsposito, Daniela
dc.date.accessioned2022-05-10T11:36:19Z
dc.date.available2022-05-10T11:36:19Z
dc.identifier.isbn978-91-8009-709-3 (PRINT)
dc.identifier.isbn978-91-8009-710-9 (PDF)
dc.identifier.urihttps://hdl.handle.net/2077/70544
dc.description.abstractBackground: Acromegaly is a systemic disease associated with multiple comorbidities. The clinical characteristics of acromegaly develop insidiously over several years and the diagnosis is usually delayed. Progress has been made in diagnostic and treatment strategies for acromegaly but whether this has led to an improvement in survival remains to be shown. The aim of this thesis was to determine mortality, morbidity, and the impact of diagnostic delay and other comorbidities on long-term outcome in patients with acromegaly. Methods: Patients with acromegaly were identified in the Swedish National Patient Registry, which was linked to five other national registries via personal identification numbers. To study mortality and morbidity in acromegaly, standardised mortality ratios (SMRs) or standardised incidence ratios (SIRs) were calculated with 95% confidence intervals (CIs) using the Swedish population as reference. To study the impact of diabetes on outcomes, patients with acromegaly and associated diabetes were compared with those without diabetes using Cox regression analysis. Results: Mortality in patients with acromegaly was increased (SMR 1.3, 95% CI 1.2–1.5) and was mainly ascribed to circulatory diseases. The diagnosis of acromegaly was delayed by a mean (SD) of 5.5 (6.2) years [median 3.3 (0.0–25.9)] and diagnostic delay had an important impact on outcome. The number of comorbidities was higher with longer diagnostic delay and mortality was significantly increased only in patients with diagnostic delay ≥10 years. Patients with acromegaly also had increased incidence of both benign (SIR 2.4, 95% CI 2.1–2.7) and malignant tumours (SIR 1.3, 95% CI 1.1–1.5). Specifically, the incidence of colorectal and anal cancer (SIR 1.5, 95% CI 1.0–2.2) as well as renal and ureteral cancer (SIR 4.0, 95% CI 2.3–6.5) was increased, while the incidence of thyroid, lung, brain, breast and prostate cancer was not. However, mortality due to malignancy was not increased. The presence of diabetes was associated with a worse outcome. In patients with acromegaly and associated diabetes, overall mortality was increased by 60% (hazard ratio [HR] 1.6, 95% CI 1.1–2.2), cardiovascular mortality 2-fold (HR 2.1, 95% CI 1.1–4.1) and the risk of cardiovascular diseases by 50% (HR 1.5, 95% CI 1.2–1.8) compared with patients without diabetes. Conclusions: Despite improvements in the management of acromegaly, prognosis is still poor, especially in patients diagnosed with a longer delay and in those with associated diabetes. These findings highlight the importance of early diagnosis and the need of optimising care of acromegaly and its associated complications to improve long-term outcome.en_US
dc.language.isoengen_US
dc.relation.haspartI. Decreasing mortality and changes in treatment patterns in patients with acromegaly from a nationwide study. Esposito D, Ragnarsson O, Granfeldt D, Marlow T, Johannsson G, Olsson DS. European Journal of Endocrinology, 2019 180 (2):X1-X3 European Journal of Endocrinology, 2018 178 (5):459-469. http://doi.org/10.1530/EJE-18-0015en_US
dc.relation.haspartII. Prolonged diagnostic delay in acromegaly is associated with increased morbidity and mortality. Esposito D, Ragnarsson O, Johannsson G, Olsson DS. European Journal of Endocrinology, 2020 182 (6):523-531. http://doi.org/10.1530/EJE-20-0019en_US
dc.relation.haspartIII. Incidence of benign and malignant tumors in patients with acromegaly is increased: a nationwide population-based study. Esposito D, Ragnarsson O, Johannsson G, Olsson DS. The Journal of Clinical Endocrinology & Metabolism, 2021 106 (12):3487-3496. http://doi.org/10.1210/clinem/dgab560en_US
dc.relation.haspartIV. Impact of diabetes on morbidity and mortality in patients with acromegaly. Esposito D, Olsson DS, Franzén S, Gudbjörnsdottir S, Miftaraj M, Nåtman J, Svensson A-M, Johannsson G. Manuscripten_US
dc.subjectAcromegalyen_US
dc.subjectmorbidityen_US
dc.subjectmortalityen_US
dc.subjectcardiovascular diseaseen_US
dc.subjectdiagnostic delayen_US
dc.subjectcanceren_US
dc.subjectdiabetesen_US
dc.titleAcromegaly - Mortality, Morbidity and Treatment Patternsen_US
dc.typetexteng
dc.type.svepDoctoral thesiseng
dc.gup.maildaniela.esposito@gu.seen_US
dc.type.degreeDoctor of Philosophy (Medicine)en_US
dc.gup.originUniversity of Gothenburg. Sahlgrenska Academyen_US
dc.gup.departmentInst of Medicine. Department of Internal Medicine and Clinical Nutritionen_US
dc.gup.defenceplaceFredagen den 3 juni 2022, kl. 9.00, Sahlgrens aula, Sahlgrenska Universitetssjukhuset, Blå Stråket 5, Göteborgen_US
dc.gup.defencedate2022-06-03
dc.gup.dissdb-fakultetSA


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