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Emerging trends in the diagnosis and treatment of acromegaly in Canada
Author(s) -
Vallette Sophie,
Ezzat Shereen,
Chik Constance,
Ur Ehud,
Imran Syed Ali,
Uum Stan,
Rivera Juan,
CasparBell Gudrun,
Serri Omar
Publication year - 2013
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.12112
Subject(s) - acromegaly , medicine , hypopituitarism , diabetes mellitus , radiation therapy , retrospective cohort study , pegvisomant , pediatrics , endocrinology , growth hormone , hormone
Summary Objective To evaluate demographic data and quality of care of patients with acromegaly in Canada and their evolution over time and secondly, to evaluate predictors of co‐morbidities and treatment outcomes. Design and patients Retrospective analyses of clinical, biochemical and treatment outcome data of 649 patients with acromegaly (males: 50·7%) followed from 1980 to 2010 (mean 10·2 years, SD 13·7) in eight tertiary care centres from six Canadian provinces. Results In comparison to 1980–1994, the number of patients referred with acromegaly in the last 15 years was higher with female preponderance (52·8% vs 41·4%, P = 0·01) and an older age at diagnosis (46·4 ± 14 vs 41·3 ± 12 years, P < 0·0001). Diabetes was present in 28%, hypertension in 37% and sleep apnoea in 33% of cases. Pretreatment IGF ‐1 levels, but not GH levels were significant predictors of diabetes ( P = 0·0002) and hypertension ( P < 0·0001). Eighty‐nine per cent of patients underwent pituitary surgery, 64·5% had medical therapy and 22% received radiotherapy. Radiotherapy was less utilized in the past 15 years (16% vs 45%, P < 0·0001). Multimodal therapy achieved remission or control of acromegaly in 70% of patients. Patients in remission or disease control had lower initial random GH ( P = 0·04) and IGF ‐1 levels ( P < 0·0001). Hypopituitarism was present in 23% of patients and cancer in 8·5%. Conclusions There was an increase over time of referral for acromegaly management with female predilection. Initial higher IGF ‐1, but not GH levels, were predictive of co‐morbidities and persistent active disease after treatment. Disease remission or control was attained in 70% of patients utilizing multimodal therapy.