Screening for acromegaly by application of a simple questionnaire evaluating the enlargement of extremities in adult patients seen at primary health care units

Abstract

The objective of this study was to screen for acromegaly by application of a simple questionnaire in patients seen at primary health care units. A total of 17,000 patients of both genders >18 and <70 years seen by general practitioner were interviewed. Patients with known pituitary disease and pregnant women were excluded. A simple questionnaire was applied to the patients: Has your shoe size increased over the last 5 years? Did you have to change your wedding ring or ring over the last 5 years because it became tight? In one patient, the diagnosis of acromegaly was suspected by the physician. Among the remaining patients, 178 (1%) responded positively to one of the items of the questionnaire and were submitted to IGF-1 measurement. Five patients had persistently elevated IGF-1 and inadequate suppression of GH in the OGTT (without other conditions associated with GH or IGF-1 elevation). One of these patients presented a normal pituitary upon magnetic resonance imaging and adenoma was detected in the other four; two presented the typical facies and two others reported changes in physiognomy (confirmed by the comparison of photographs), in addition to the enlargement of extremities. The present investigation suggests a much higher prevalence of acromegaly in the adult population than that reported traditionally. We propose that screening based on phenotypic alterations is cost-effective since these changes occur early and almost universally in acromegaly and are uncommon in the general population.

The prevalence of acromegaly in hospitalized patients with type 2 diabetes

“…in primary health-care clinics led to the estimated prevalence of acromegaly to be revised to 29/100,000 [7]. In another study, the results of screening of 6,773 adults from a general primary care population in Germany for serum IGF-1 levels suggested a prevalence of acromegaly as high as 103/100,000 [8].…”

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

“…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.…”

Symptoms and signs of acromegaly: an ongoing need to raise awareness among healthcare practitioners

“…In a primary healthcare study, 17 000 patients were screened using a questionnaire that evaluated enlargement of extremities. 9 Although pre-test probabilities of the questionnaire were not made available, the authors proposed that screening based on phenotypic changes is cost-effective. However, population screening for acromegaly using biochemical assays have a low detection rate and incur unnecessary costs.…”