Acromegaly is associated with increased cancer risk: a survey in Italy

    1. for the Italian Study Group of Acromegaly*
    1. 1Internal Medicine 1, Department of Clinical and Biological Sciences, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
    2. 2Statistical Unit, Department of Clinical and Biological Sciences, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
    3. 3Endocrinology and Diabetology Unit, Fondazione IRCCS Ca` Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
    4. 4Pituitary Unit, Department of Endocrinology, Catholic University of the Sacred Heart, Rome, Italy
    5. 5Division of Endocrinology, Department of Clinical Medicine and Surgery, University Federico II di Napoli, Naples, Italy
    6. 6Division of Endocrinology, Diabetes and Metabolism, Department of Medical Science, University of Turin, ASOU Città della Salute e della Scienza, Turin, Italy
    7. 7Pituitary Unit, Department of Neurosurgery, San Raffaele Scientific Institute, University ‘Vita- Salute’, Milan, Italy
    8. 8Department of Clinical and Experimental Medicine-Endocrinology Unit, University of Messina, Messina, Italy
    9. 9Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DiMI), Center of Excellence for Biomedical Research (CEBR) IRCCS, AOU San Martino-IST, San Martino Hospital, University of Genova, Genova, Italy
    10. 10Ambulatori di Endocrinologia, Humanitas Gavazzeni, Bergamo, Italy
    11. 11Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
    12. 12Internal Medicine, San Valentino Hospital, Montebelluna, Treviso, Italy
    13. 13Internal Medicine, Department of Medicine, DIMED, University of Padova, Padova, Italy
    14. 14Department of Medicine, Section of Internal Medicine and Endocrine and Metabolic Sciences, University of Perugia, Perugia, Italy
    15. 15Department of Internal Medicine, Section of Endocrinology and Metabolism, University of Modena, Modena, Italy
    16. 16Endocrine Unit, Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’, University of Florence, Florence, Italy
    17. 17IRCCS Istituto delle Scienze Neurologiche di Bologna (ISNB), Bologna, Italy
    18. 18Endocrinology, AO Garibaldi-Nesima, Catania, Italy
    19. 19Endocrinology and Diabetes, Department of Medical Sciences, University of Cagliari, Cagliari, Italy
    20. 20Division of Endocrinology and Metabolism, Santa Croce and Carle Hospital, Cuneo, Italy
    21. 21Endocrinology Unit, Department of Medicine, DIMED University of Padua, Padua, Italy
    22. 22Endocrinology, Sant’Antonio Abate Hospital, Gallarate, Varese, Italy
    23. 23Endocrinology Unit A.O. San Camillo - Forlanini, Rome, Italy
    24. 24Division of Endocrine and Metabolic Diseases, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy
    1. Correspondence should be addressed to G Reimondo; Email: giuseppe.reimondo{at}


    It is debated if acromegalic patients have an increased risk to develop malignancies. The aim of the present study was to assess the standardized incidence ratios (SIRs) of different types of cancer in acromegaly on a large series of acromegalic patients managed in the somatostatin analogs era. It was evaluated the incidence of cancer in an Italian nationwide multicenter cohort study of 1512 acromegalic patients, 624 men and 888 women, mean age at diagnosis 45 ± 13 years, followed up for a mean of 10 years (12573 person-years) in respect to the general Italian population. Cancer was diagnosed in 124 patients, 72 women and 52 men. The SIRs for all cancers was significantly increased compared to the general Italian population (expected: 88, SIR 1.41; 95% CI, 1.18–1.68, P < 0.001). In the whole series, we found a significantly increased incidence of colorectal cancer (SIR 1.67; 95% CI, 1.07–2.58, P = 0.022), kidney cancer (SIR 2.87; 95% CI, 1.55–5.34, P < 0.001) and thyroid cancer (SIR 3.99; 95% CI, 2.32–6.87, P < 0.001). The exclusion of 11 cancers occurring before diagnosis of acromegaly (all in women) did not change remarkably the study outcome. In multivariate analysis, the factors significantly associated with an increased risk of malignancy were age and family history of cancer, with a non-significant trend for the estimated duration of acromegaly before diagnosis. In conclusion, we found evidence that acromegaly in Italy is associated with a moderate increase in cancer risk.

    • Received 18 June 2017
    • Accepted 13 July 2017
    • Made available online as an Accepted Preprint 14 July 2017
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