Early Manifestations, Sex Differences May Aid in Acromegaly Diagnosis

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The most common characteristics at diagnosis were morphologic (enlarged hands, enlarged feet), facial modifications (frontal bump, enlarged nose), snoring syndrome, and asthenia.
The most common characteristics at diagnosis were morphologic (enlarged hands, enlarged feet), facial modifications (frontal bump, enlarged nose), snoring syndrome, and asthenia.

Wide-ranging manifestations of acromegaly often delay diagnosis and postpone treatment, but some sex differences may help physicians identify the disease earlier, according to an epidemiological study published in Endocrine.

Researchers in this cross-sectional, multicenter, observational study analyzed data from case reports, patient questionnaires, and medical information to describe the most common signs, symptoms, demographics, and comorbidities present at diagnosis of acromegaly.

Of 472 patients with acromegaly, 42.8% were men, 80.5% had macroadenoma, and mean age was 51.9 years old. The most common characteristics at diagnosis were morphologic (enlarged hands, enlarged feet), facial modifications (frontal bump, enlarged nose), snoring syndrome, and asthenia. Women tended to experience more headaches, carpal tunnel syndrome, constipation, and thyroid nodules compared with male participants, while men experienced more prognathism, sleep apnea, congestive heart failure, and erection disorders. 

Post hoc analysis indicated that functional signs — snoring, weight gain, loss of libido, asthenia, rachialgia, and arthropathy — were the most predominant manifestations that were missed at diagnosis. Prior to diagnosis, enlarged hands and feet and hypertension were the most frequent manifestation. The average time between manifestation and diagnosis was 14.2 ± 11.3 years. The earliest clinically relevant manifestations for women tended to be thyroid nodules, while early manifestations for men tended to be enlarged hands, weight gain, and a husky voice.

The study relied on self-reported questionnaires and patient recollection, which could lead to recall biases. However, patients with a time since diagnosis of >5 years were excluded to mitigate this bias.

Overall, the study described the signs, symptoms, and comorbidities in the years prior to acromegaly diagnosis and reported on differences between men and women in their clinical manifestations. The study results may aid physicians in detecting and diagnosing acromegaly earlier in the disease process.

This study was supported by Ispen Pharma. Please refer to reference for a complete list of authors' disclosures.

Reference

Caron P, Brue T, Raverot G, et al. Signs and symptoms of acromegaly at diagnosis: the physician's and the patient's perspectives in the ACRO-POLIS study [published online September 29, 2018]. Endocrine. doi:10.1007/s12020-018-1764-4

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