Clinical features and complications of acromegaly at diagnosis are not all the same: data from two large referral centers

Abstract

Purpose: The number of international acromegaly-related registries is increasing; however, heterogeneity of acromegaly symptoms and signs across countries is not well described. We compared clinical disease manifestations at diagnosis between two large University referral centers from two continents. Methods: Retrospective, comparative epidemiological study of acromegaly patients at two centers; 1) C. I. Parhon National Institute of Endocrinology, “Carol Davila” University of Medicine and Pharmacy Bucharest, Romania (Parhon), and 2) Pituitary Center, Oregon Health & Science University, Portland, Oregon, United States (OHSU) from approved registries was undertaken. Data were extracted from medical charts and questionnaires. Binary logistic regression analysis was undertaken for the most frequently noted symptoms and clinical signs. Results: Study included 216 patients (87 Parhon, 129 OHSU). Age, sex and median delay in diagnosis were similar between centers. IGF-1 index was higher in patients at Parhon (3.3 vs 2.1, p < 0.001). The top five symptoms at both centers were; enlarged hands/feet, headache, arthralgia, fatigue, and irregular menses in women. A significant difference was noted for multiple signs and symptoms frequency, often >20 percentage points between centers. Center was a predictor of many signs and symptoms, independent of acromegaly biochemical severity or disease duration. Conclusion: We show in the first comparative study that differences in medical practice, documentation, and likely cultural differences can influence patients’ symptom(s) reporting and screening patterns in geographically different populations. Pooling data into large multicenter international registries databases may lead to loss of regional characteristics and thus a mixed overall picture of combined cohorts.

Historical and Future Trends in Emergency Pituitary Referrals: A Machine Learning Analysis

“…The consistent referral volume despite this is in contrast to neurosurgical referrals for other acute cranial and spinal pathologies, which experienced a considerable reduction in referrals [17][18][19]. The frequent sight or life-threatening presentation of pituitary tumours and anatomically-adjacent pathologies in this cohort could explain this [1,6] and may be a sufficient reason for patients to present, overcoming various fears associated with hospitals and COVID-19 transmission during the pandemic [20,21]. Nevertheless, the number of pituitary and skull base surgeries performed in the UK did decrease during the COVID pandemic, including in our centre.…”

“…Nevertheless, the number of pituitary and skull base surgeries performed in the UK did decrease during the COVID pandemic, including in our centre. This occurred in the context of limited operating capacity, an evolving understanding of the theorised viral transmission risk of these surgeries, and the development of updated clinical guidelines for the management of these tumours [6,8,22], all impacting upon surgical decision-making and technique. Consequently, a significant proportion of patients with pituitary disease were affected, resulting in delays or changes to their planned care [8,22].…”

“…Diverse clinical presentations, as well as multiple potential venues for interaction with healthcare services, can result in a wide range of patient pathways and journeys [2][3][4]. This poses a challenge to healthcare services and may contribute toward delays in correct diagnosis and definitive management (e.g., surgery) [5,6]. This is of particular importance for patients requiring urgent treatment, including those presenting with rapidly declining vision and other acute neurological deficits.…”

Acromegalia: differenze di sesso e genere

“…Nello specifico, sintomi compatibili con l'acromegalia sono stati riscontrati più frequentemente nel centro americano, a parità di età e sesso delle popolazioni studiate. Inoltre, l'età delle donne era maggiore nel Centro rumeno, suggerendo una diagnosi più precoce in America [10].…”

Optimization of the follow-up and treatment of patients with acromegaly with the SAGIT^® tool

“…Эта ситуация не уникальна и встречается как в других регионах России, так и в других странах. Кроме того, как было показано в специальном исследовании по сравнению двух центров, курирующих пациентов с акромегалией, могут практиковаться различные подходы к диагностике и лечению [20]. Международные профессиональные сообщества и Российская ассоциация эндокринологов регулярно обновляют клинические рекомендации, тем самым создаются объективные условия для того, чтобы врач с любым уровнем знаний мог оказать пациенту квалифицированную медицинскую помощь [1-3, 5, 6].…”