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

Abstract

INTRODUCTION Chronic excess growth hormone production results in acromegaly, a condition associated with widespread physical changes, including soft tissue and bony overgrowth. When untreated, acromegaly reduces life expectancy. Patients usually remain undiagnosed for years after the onset of symptoms, by which stage irreversible physical changes have often occurred. METHOD A cross-sectional questionnaire study involving patients with acromegaly from the Waikato Endocrine Unit and the New Zealand Acromegaly Society evaluated features of acromegaly that were present before diagnosis. The aim of this study was to identify acromegaly features that were most prevalent to promote increased awareness about the disease by healthcare providers. RESULTS 81 participants were included. The main pre-diagnosis physical changes participants reported were acral changes, alterations in facial features and oral symptoms. For some, these features were present for more than 10 years before the acromegaly diagnosis. Multiple co-morbidities associated with acromegaly were reported. Two-thirds of the participants felt that an earlier diagnosis was possible. Most participants were in contact with General Practitioners (GPs) and/or dentists before diagnosis. Endocrinologists had the highest diagnosis rate, followed by GPs. Dentists had a low diagnosis rate despite a high prevalence of oral symptoms among study participants. CONCLUSION Increased awareness of acromegaly among primary care clinicians is important as they are the first-point-of-contact with the healthcare system for most patients. Health professionals’ early recognition of symptoms and signs of acromegaly would reduce delays in time-to-diagnosis, enable earlier treatment and may improve outcomes for patients with acromegaly. MESH KEYWORDS Acromegaly; symptoms; delayed diagnosis; clinicians; primary healthcare

The role of the dentist and orthodontist in recognizing oro-facial manifestations of acromegaly: a questionnaire-based study

“…Some studies in literature [8,26] revealed that about 80% of the ACRO under examination had oral-dental-facial disorders, in particular macroglossia (54-58%), dental diastema (40-43%), mandibular growth (22-24%), and mandibular prognathism (20-22%). Another study confirmed that [18] oral cavity and face somatic changes in acromegaly patients are present up to 10 years before diagnosis. In particular, it emphasized how facial changes are among the most common signs, being the third most frequent alteration at diagnosis, immediately after the increase in the size of feet and hands.…”

“…Our results therefore seem to be in line with those reported in the literature, in which dentists do not seem to have a fundamental role in the diagnostic path of these patients, despite a long term follow-up with a collection of photographic and radiographic documentation. In the literature, it is well known [18,20] that dentists are among the clinicians most consulted by patients before diagnosis and these data emphasize the potential role of this medical practitioner, who could be the first specialist to notice the early signs of acromegaly [22,23]. Moreover, another study [8] points out that despite a significant percentage of acromegalic patients evaluated for dental care prior to diagnosis, less than 5% of these are referred to a specialist due to suspected acromegaly.…”

Selective screening of patients with associated somatic diseases as a method of early detection of acromegaly

“…Недостаток клинических знаний об акромегалии и отсутствие системы квалифицированного диагностического поиска влияют на существенное увеличение срока от первых проявлений заболевания до его выявления (timelag). Согласно эпидемиологическим данным, у 54% больных timelag составляет более 10 лет, а у 37% больных -более 15 лет, что значительно ухудшает прогноз заболевания, который обратно коррелирует с паспортным возрастом пациентов, длительностью активной стадии заболевания и уровнем ГР [8][9][10][11].…”

Pituitary adenomas

“…Diagnosis may be missed due to a gradual manifestation of hormone hypersecretion over the course of years, with non-specific symptoms and subclinical disease at first. On average, diagnosis is delayed by 6-7 years from first symptom onset in acromegaly67 and 3-4 years for Cushing’s disease,8 largely because of this insidious symptom onset.…”