Screening for acromegaly in adult patients not reporting enlargement of the extremities, but with arterial hypertension associated with another comorbidity of the disease

Rosário, Pedro Weslley; Calsolari, Maria Regina

doi:10.1590/0004-2730000003314

Cited by 10 publications

(8 citation statements)

References 31 publications

(53 reference statements)

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“…Previous studies that screened for acromegaly in the general population [11], and in hypertensive [12], diabetic [3] or carpal tunnel syndrome patients [13] found similar results to ours. In patients with existing comorbidities, the only clinical indicators of acromegaly are obvious facial dysmorphism and enlargement of the extremities.…”

supporting

confidence: 89%

Acromegaly in sleep apnoea patients: a large observational study of 755 patients

et al. 2016

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Polycyclic aromatic hydrocarbons (PAHs) at traffic and urban background sites of northern Greece: source apportionment of ambient PAH levels and PAH-induced lung cancer risk. Environ Sci Pollut Res Int 2016; 23: 3556-3568. 13 Tsiligianni IG. COPD patients trapped in the financial crisis in rural Crete. Lancet Respir Med 2013; 1: e31-e32. 14 Bakogeorgos M, Mountzios G, Bournakis E, et al. Do elderly patients with non-small cell lung cancer get the best out of recent advances in first-line treatment? A comparative study in two tertiary cancer centers in Greece.

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confidence: 89%

Acromegaly in sleep apnoea patients: a large observational study of 755 patients

et al. 2016

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confidence: 99%

“…Previous studies screened cohorts with other comorbidities such as arterial hypertension [18] and diabetes mellitus or glucose intolerance [6]. In both studies, the frequency of acromegaly was too low to justify general screening, especially in the absence of a typical acromegalic phenotype [6,18]. This was explained by the fact that both conditions (arterial hypertension and diabetes mellitus or glucose intolerance) are common in acromegaly, but are also very common in the general population, thus being not specific enough to identify patients with early acromegaly [7].…”

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confidence: 99%

Screening for Acromegaly in Patients with Carpal Tunnel Syndrome: A Prospective Study (ACROCARP)

et al. 2016

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Early diagnosis of acromegaly prevents irreversible comorbidities and facilitates surgical cure. Carpal tunnel syndrome (CTS) is common in acromegaly and patients have often undergone surgery for CTS prior to the diagnosis of acromegaly. We hypothesized that screening CTS-patients for acromegaly could facilitate active case-finding. We prospectively enrolled 196 patients [135 women, 56.9 (range 23-103) years] who presented with CTS for surgery. Patients were asked about 6 symptoms suggestive of acromegaly using a questionnaire calculating a symptom score (0-6 points), and insulin-like-growth factor 1 (IGF-1) was measured. If IGF-1 was increased, IGF-1 measurement was repeated, and random growth hormone (GH) and/or an oral glucose tolerance test (OGTT) with assessment of GH-suppression were performed. The mean symptom score was 1.7±1.3 points. Three patients reported the maximal symptom score of 6 points, but none of them had an increased IGF-1. There was no correlation between the symptom score and IGF-1-SDS (standard deviation score) (r=0.026; p=0.71). Four patients had an IGF-1>2 SDS. In 2 patients acromegaly was ruled out using random GH and OGTT. One patient had normal IGF-1 and random GH at follow-up. One patient refused further diagnostics. In this prospective cohort of patients with CTS, the observed frequency of acromegaly was at most 0.51% (95% CI 0.03 to 2.83%). In this prospective study, none of the 196 patients with CTS had proven acromegaly. Thus, we see no evidence to justify general screening of patients with CTS for acromegaly.

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“…First, 4,350 adults (age between 18 and 70 years, excluding pregnant women and patients with known pituitary disease) underwent acromegaly screening: 2,270 patients with type 2 diabetes mellitus or glucose intolerance (19), 178 patients who reported "enlargement of their extremities" (20), and 1,902 patients with two or more comorbidities related to acromegaly [including arterial hypertension in 1,806 patients (21)]. In patients with elevated IGF-1, a new measurement was obtained and was combined with the measurement of GH during an OGTT.…”

Section: Patientsmentioning

confidence: 99%

Long-term follow-up of patients with elevated IGF-1 and nadir GH > 0.4 µg/L but < 1 µg/L

Rosário

Calsolari

2017

Arch. Endocrinol. Metab.

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Objective: To report the results of initial investigation and after 5 years of patients with a suspicious clinical scenario for acromegaly, elevated IGF-1, and nadir GH during an oral glucose tolerance test (OGTT) > 0.4 µg/L but < 1 µg/L. Subjects and methods: Seventeen patients who had elevated IGF-1 (outside puberty and pregnancy) in two measurements and GH between 0.4 and 1 µg/L during OGTT were selected. Results: During initial assessment, only one patient had microadenoma on magnetic resonance imaging (MRI) of the pituitary. In this patient, IGF-1 returned to normal spontaneously after 5 years. In the remaining 16 patients, spontaneous normalization of IGF-1 was observed in four and IGF-1 continued to be elevated in 12 after 5 years. None of the latter patients developed a phenotype of acromegaly, changes in physiognomy or increase in IGF-1 and no tumor was detected by imaging methods. Two patients had nadir GH < 0.4 µg/L, while the nadir GH remained between 0.4 and 1 µg/L in 10 patients. Conclusion: In patients (notably young adult or adult women) without a typical phenotype in whom IGF-1 is measured due to a suspicious clinical scenario and is found to be slightly elevated, even if confirmed and in the absence of other causes, a nadir GH cut-off value of 0.4 µg/L instead of 1 µg/L in the OGTT might be inadequate for the diagnosis. Arch Endocrinol Metab. 2017;61(5):426-31

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Screening for acromegaly in adult patients not reporting enlargement of the extremities, but with arterial hypertension associated with another comorbidity of the disease

Cited by 10 publications

References 31 publications

Acromegaly in sleep apnoea patients: a large observational study of 755 patients

Acromegaly in sleep apnoea patients: a large observational study of 755 patients

Screening for Acromegaly in Patients with Carpal Tunnel Syndrome: A Prospective Study (ACROCARP)

Long-term follow-up of patients with elevated IGF-1 and nadir GH > 0.4 µg/L but < 1 µg/L

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