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Features at diagnosis of 324 patients with acromegaly did not change from 1981 to 2006: acromegaly remains under‐recognized and under‐diagnosed
Author(s) -
Reid Tirissa J.,
Post Kalmon D.,
Bruce Jeffrey N.,
Nabi Kanibir M.,
ReyesVidal Carlos M.,
Freda Pamela U.
Publication year - 2010
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/j.1365-2265.2009.03626.x
Subject(s) - acromegaly , medicine , diabetes mellitus , disease , retrospective cohort study , pediatrics , carpal tunnel syndrome , comorbidity , surgery , endocrinology , growth hormone , hormone
Summary Background Traditionally, acromegaly evaded diagnosis until in its clinically obvious later stages when treatment is more difficult. Over the last 25 years diagnostic tests have improved, but whether clinical disease detection also improved was unknown, so we tested if disease severity at diagnosis had changed from 1981 to 2006. Methods Data on 324 consecutive acromegaly patients presenting from 1981 to 2006 at two New York City hospitals were collected by retrospective review ( n = 324) and by interview ( n = 200). The main complaint, acromegaly associated comorbidities, signs, symptoms, healthcare providers visited, preoperative GH and IGF‐I levels and pituitary tumour size at diagnosis were compared in patients presenting in the earlier vs. later halves of the time period. Results Times from symptom onset to diagnosis were 5·9 year (early) vs. 5·2 year (late; P = NS). At diagnosis, 96% of early and late groups had facial feature changes and/or hand/foot enlargement. Comorbidities included hypertension 37% (early) vs. 36% (late), carpal tunnel syndrome (24% vs. 24%), sleep apnoea (13% vs. 29%; P < 0·01), osteoarthritis (25% vs. 23%) and diabetes mellitus (18% vs. 15%); each patient had 1·2 (early) vs. 1·3 (late; P = 0·53) comorbidities. Groups were similar in signs, symptoms, tumour size, GH and IGF‐I. Conclusions Clinical, biochemical and tumour size characteristics at diagnosis of acromegaly patients were unchanged from 1981 to 2006. Most patients still have marked manifestations of acromegaly at diagnosis, suggesting that acromegaly remains clinically under‐recognized. Healthcare professionals should more commonly consider acromegaly, which can lead to earlier diagnosis and better treatment outcome.