PURPOSE Achieving biochemical control (normalization of insulin-like growth factor-1 [IGF-1] and growth hormone [GH]) is a key goal in acromegaly management. However, IGF-1 and GH fluctuate over time. The true potential impact of time-varying biochemical control status on comorbidities is unclear and relies on multiple, longitudinal IGF-1 and GH measurements. This study assessed the association between time-varying biochemical control status and onset of selected comorbidities in patients with acromegaly. METHODS Medical charts of adults with confirmed acromegaly and ≥ 6 months of follow-up at an Italian endocrinology center were reviewed. Patients were followed from the first diagnosis of acromegaly at the center until loss to follow-up, chart abstraction, or death. Biochemical control status was assessed annually and defined as IGF-1 ≤ the upper limit of normal, or GH ≤ 2.5 µg/L in the few cases where IGF-1 was unavailable. Time-varying Cox models were used to assess the association between biochemical control status and comorbidities. RESULTS Among 150 patients, 47% were female, average age at diagnosis was 43.1, and mean length of follow-up was 10.4 years. Biochemical control was significantly associated with a lower hazard of diabetes (HR = 0.36, 95% CI 0.15; 0.83) and cardiovascular system disorders (HR = 0.54, 95% CI 0.31; 0.93), and a higher hazard of certain types of arthropathy (HR = 1.68, 95% CI 1.04; 2.71); associations for other comorbidities did not reach statistical significance. CONCLUSION Results further support the importance of achieving biochemical control, as this may reduce the risk of high-burden conditions, including diabetes and cardiovascular system disorders. The association for arthropathy suggests irreversibility of this impairment. Due to limitations, caution is required when interpreting these results.

中文翻译：

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肢端肥大症患者生化控制与合并症之间的关联：一项意大利纵向回顾性图表回顾研究。

目的 实现生化控制（胰岛素样生长因子-1 [IGF-1] 和生长激素 [GH] 的正常化）是肢端肥大症管理的一个关键目标。然而，IGF-1 和 GH 随时间波动。时变生化控制状态对合并症的真正潜在影响尚不清楚，并且依赖于多个纵向 IGF-1 和 GH 测量。本研究评估了肢端肥大症患者随时间变化的生化控制状态与选定合并症发病之间的关联。方法 回顾了意大利内分泌中心确诊肢端肥大症和≥6个月随访的成人病历。患者从中心首次诊断为肢端肥大症开始，直至失访、图表提取或死亡。每年评估生化控制状态，定义为 IGF-1 ≤ 正常上限，或在 IGF-1 不可用的少数情况下，GH ≤ 2.5 µg/L。时变 Cox 模型用于评估生化控制状态与合并症之间的关联。结果 150 例患者中，47% 为女性，平均诊断年龄为 43.1 岁，平均随访时间为 10.4 年。生化控制与较低的糖尿病风险（HR = 0.36, 95% CI 0.15; 0.83）和心血管系统疾病（HR = 0.54, 95% CI 0.31; 0.93）以及某些类型关节病的较高风险显着相关（ HR = 1.68, 95% CI 1.04; 2.71); 其他合并症的关联没有达到统计学意义。结论 结果进一步支持实现生化控制的重要性，因为这可以降低高负担疾病的风险，包括糖尿病和心血管系统疾病。关节病的关联表明这种损伤是不可逆的。由于限制，在解释这些结果时需要谨慎。