Acromegaly in Iraq: Brief Look on Epidemiology, Comorbidities and Management
Keywords:Acromegaly, Growth Hormone, Insulin-Like Growth Factor-1, Pituitary Adenoma
Objective: Acromegaly is a rare chronic condition in adults resulted from continuous over secretion of growth hormone (GH) and hence increased production of insulin-like growth factor-1 (IGF-1). Pituitary adenoma is the underlying cause in vast majority of cases. This study aims to evaluate clinico-epidemiological characteristics for a group of Iraqi individuals with this disease.
Method: Case notes and files of 60 acromegalic patients attending Iraqi National Diabetes Center were reviewed during period of October through December 2017. To be included, the diagnosis of acromegaly should be confirmed by appropriate laboratory and imagining techniques. Disease control and biochemical response to management was defined by the criteria of normalized IGF-1 for age and sex (Z-score â‰¤ 2) and a mean GH value â‰¤ 2 Î¼g/l. Data was entered and analyzed using SPSS program, version 20. Descriptive statistics was used; presented as frequencies and proportions, or means and standard deviations according to variable type.
Results: Patients were almost equally distributed among both sexes. Their mean age is 50.6 Â± 11.7 years. Time interval between symptoms' onset and diagnosis was nearly 10 years. Macroadenoma (> 1cm) was found in 47 (78.3%) patients. Diabetes mellitus and hypertension affected 42 (70.0%) and 37 (61.7%) individuals, respectively. For disease control, all acromegalics were put on long-acting somatostatin analogue and 21 (35.0%) of them performed hypophysectomy. In 45 (75.0%) patients, growth hormone value was dropped to â‰¤2 mg/l; and in 41 (68.3%), IGF-1 was normalized for age and sex.
Conclusion: The clinco-epidemiological characteristics of acromegaly in Iraq are comparable to that reported in other countries, although there is some delay in time of diagnosis. Associated comorbidities (diabetes and hypertension) affected large number of patients. Good proportion of study sample, nearly two-thirds, showed good metabolic response to treatment.
2. Chanson P, Salenave S. Acromegaly. Orphanet Journal of Rare Diseases. 2008;3:17.
3. Dineen R, Stewart PM, Sherlock M. Acromegaly. QJM: An International Journal of Medicine. 2017;110(7):411â€“20.
4. Reid TJ, Post KD, Bruce JN, Nabi KM, Reyes-Vidal CM, Freda PU. Features at diagnosis of 324 patients with acromegaly did not change from 1981 to 2006: acromegaly remains under-recognized and under-diagnosed. Clin Endocrinol. 2010;72(2):203â€“8.
5. Sherlock M, Ayuk J, Tomlinson JW, Toogood AA, Aragon-Alonso A, Sheppard MC, et al. Mortality in patients with pituitary disease. Endocr Rev. 2010;31:301â€“42.
6. Alexopoulou O, Bex M, Abs R, Tâ€™Sjoen G, Velkeniers B, Maiter D. Divergence between growth hormone and insulin-like growth factor-I concentrations in the follow-up of acromegaly. J Clin Endocrinol Metab. 2008;93:1324-1330.
7. Bex M, Abs R, T'Sjoen G, Mockel J, Velkeniers B, Muermans K, et al. AcroBel--the Belgian registry on acromegaly: a survey of the 'real-life' outcome in 418 acromegalic subjects. Eur J Endocrinol. 2007;157(4):399-409.
8. Dal J, Feldt-Rasmussen U, Andersen M, Kristensen L, Laurberg P, Pedersen L. Acromegaly incidence, prevalence, complications, and long-term prognosis: A nationwide cohort study. European Journal of Endocrinology. 2016;175:181â€“90.
9. Burton T, Le Nestour E, Neary M, Ludlam WH. Incidence and prevalence of acromegaly in a large US health plan database. Pituitary. 2016;19(3):262-7.
10. Vallette S, Ezzat S, Chik C, Ur E, Imran SA, Uum SV. Emerging trends in the diagnosis and treatment of acromegaly in Canada. Clinical Endocrinology. 2013;79(1):79-85.
11. Lavrentaki A, Paluzzi A, Wass JA, Karavitaki N. Epidemiology of acromegaly: review of population studies. Pituitary. 2017;20(1):4-9.
12. CannavÃ² S, FerraÃ¹ F, Ragonese M, CurtÃ² L, Torre ML, Magistri M, et al. Increased prevalence of acromegaly in a highly polluted area. Eur J Endocrinol. 2010;163(4):509-13.
13. Hassan RZ, Conaglen HM, Conaglen JV, Elston MS. Symptoms and signs of acromegaly: an ongoing need to raise awareness among healthcare practitioners. J Prim Health Care. 2016;8(2):157â€“163.
14. Mestron A, Webb SM, Astorga R, Benito P, Catala M, Gaztambide S, et al. Epidemiology, clinical characteristics, outcome, morbidity and morÂ¬tality in acromegaly based on the Spanish Acromegaly Registry (Registro Espanol de Acromegalia, REA). Eur J Endocrinol. 2004;151:439-446.
15. Melmed S. Medical progress: Acromegaly. N Engl J Med. 2006;14;355(24):2558-73.
16. Abreu A, Tovar AP, Castellanos R, Valenzuela A, Giraldo CM, Pinedo AC, et al. Challenges in the diagnosis and management of acromegaly: a focus on comorbidities. Pituitary. 2016;19(4):448-57.
17. Colao A, Auriemma RS, Savastano S, Galdiero M, Grasso LF, Lombardi G, et al. Glucose tolerance and somatostatin analog treatment in acromegaly: a 12-month study. J Clin Endocrinol Metab. 2009;94(8):2907-14.
18. Alexopoulou O, Bex M, Kamenicky P, Mvoula AB, Chanson P, Maiter D. Prevalence and risk factors of impaired glucose tolerance and diabetes mellitus at diagnosis of acromegaly: a study in 148 patients. Pituitary. 2014;17(1):81-9.
19. Dreval AV, Trigolosova IV, Misnikova IV, Kovalyova YA, Tishenina RS, Barsukov IA, et al. Prevalence of diabetes mellitus in patients with acromegaly. Endocrine Connections. 2014;3(2):93-98.
20. Badiu C. Effect of somatostatin analogues on glucose metabolism in acromegaly: friend of foe? AACE Clinical Case Rep. 2016;2(4):374-375.
21. Parkinson C, Drake WM, Roberts ME, Meeran K, Besser GM, Trainer PJ. A comparison of the effects of pegvisomant and octreotide on glucose, insulin, gastrin, cholecystokinin, and pancreatic polypeptide responses to oral glucose and a standard mixed meal. J Clin Endocrinol Metab. 2002;87(4):1797-804.
22. Ronchi C, Epaminonda P, Cappiello V, Beck-Peccoz P, Arosio M. Effects of two different somatostatin analogs on glucose tolerance in acromegaly. J Endocrinol Invest. 2002;25(6):502-7.
23. Baldelli R, Battista C, Leonetti F, Ghiggi MR, Ribaudo MC, Paoloni A, et al. Glucose homeostasis in acromegaly: effects of long-acting somatostatin analogues treatment. Clin Endocrinol (Oxf). 2003;59(4):492-9.
24. Mazziotti G, Floriani I, Bonadonna S, Torri V, Chanson P, Giustina A. Effects of somatostatin analogs on glucose homeostasis: a metaanalysis of acromegaly studies. J Clin Endocrinol Metab. 2009;94(5):1500â€“1508
25. Lombardi G, Galdiero M, Auriemma RS, Pivonello R, Colao A. Acromegaly and the cardiovascular system. Neuroendocrinology. 2006;83:211-217.
26. Bondanelli M, Ambrosio MR, degli Uberti EC. Pathogenesis and prevalence of hypertension in acromegaly. Pituitary. 2001;4(4):239-49.
27. Vitale G, Pivonello R, Auriemma RS, Guerra E, Milone F, Savastano S. Hypertension in acromegaly and in the normal population: prevalence and determinants. Clin Endocrinol (Oxf). 2005;63(4):470-6.
28. Roelfsema F, Biermasz NR, Frolich M, Keenan DM, Veldhuis JD, Romijn JA. Diminished and irregular thyrotropin secretion with preserved diurnal rhytm in patients with active acromegaly. J Clin Endocrinol Metab. 2009;94:1945â€“50.
29. DÄ…browska AM, Tarach JS, Kurowska M, Nowakowski A. Thyroid diseases in patients with acromegaly. Arch Med Sci. 2014;10(4):837â€“845.
30. Beck-Peccoz P, Persani L, Lania A. Thyrotropin-Secreting Pituitary Adenomas. [Updated 2015 May 1]. In: De Groot LJ, Chrousos G, Dungan K, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK278978/
31. Socin HV, Chanson P, Delemer B, Tabarin A, Rohmer V, Mockel J, et al. The changing spectrum of TSH-secreting pituitary adenomas: diagnosis and management in 43 patients. Eur J Endocrinol. 2003;148(4):433-42.
32. Shestakova T, Dreval A, Ilovaiskaja I, Zaharevich E. Study thyroid function in patients with acromegaly. Endocrine Abstracts. 2012;29:17-15.
33. Uchoa HB, Lima GA, CorrÃªa LL, Vidal AP, Cavallieri SA, Vaisman M, et al. Prevalence of thyroid diseases in patients with acromegaly: experience of a Brazilian center. Arq Bras Endocrinol Metabol. 2013;57(9):685-90.
34. Kauppinen-MÃ¤kelin R, Sane T, Reunanen A, VÃ¤limÃ¤ki PJ, Niskanen L, Markkanen H, et al. A nationwide survey of mortality in acromegaly. Journal of Clinical Endocrinology and Metabolism. 2005;90:4081â€“4086.