High prevalence of biochemical acromegaly in primary care patients with elevated IGF‐1 levels
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Summary Objective The estimated prevalence of acromegaly is 40–125 per million. The diagnosis of acromegaly is often delayed due to deficits in recognizing the signs of the disease. It is not known how many subjects with increased IGF‐1 levels have acromegaly. We aimed to assess the prevalence of acromegaly in primary care by screening for elevated IGF‐1 levels. Design A cross‐sectional, epidemiological study (the DETECT study). Patients A total of 6773 unselected adult primary care patients were included. Measurements We measured IGF‐1 in all patients and recommended further endocrine evaluation in all patients with elevated IGF‐1 levels (> 2 age‐dependent SDS). Results Of 125 patients with elevated IGF‐1 levels, 76 patients had indeterminate results and acromegaly could be excluded in 42 patients. One patient had known florid acromegaly. Two patients had newly diagnosed acromegaly and pituitary adenomas. Four patients had biochemical acromegaly but refused further diagnostics. This corresponds to a prevalence of 1034 per million patients. Conclusions Our study shows a high prevalence of undiagnosed acromegaly in primary care. These results imply that acromegaly is underdiagnosed and stress the importance of detecting acromegaly.This book contains five sections, each consisting of several papers. The section headings are: Biochemistry and Physiology of GH and Growth Factors, Pathology of Acromegaly, Clinical Endocrinology of Acromegaly, Nonsurgical Therapy of Acromegaly, and Surgical Therapy of Acromegaly.
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Pituitary disorder
Human physiology
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Feline acromegaly is a disease characterized by excessive growth hormone secretion leading to a wide array of clinical signs caused by the hormones' effects on multiple organ systems. This chapter discusses the etiology/pathophysiology and epidemiology, history and clinical signs, diagnosis, and treatment of feline acromegaly. Feline acromegaly has similarities to human acromegalic families with aryl-hydrocarbon-receptor interacting protein mutations. Feline acromegaly most commonly affects middle-aged to older, male castrated cats. Most patients with acromegaly present for insulin-resistant diabetes mellitus with concurrent weight gain rather than weight loss. Radiographic findings associated with feline acromegaly are related to the hypertrophic effects of excessive growth hormone. Surgical removal of the pituitary tumor (adenectomy) is the treatment of choice for acromegaly in human medicine. The procedure can be performed in cats and dogs, usually employing complete removal of the entire pituitary (hypophysectomy).
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Summary Objective The estimated prevalence of acromegaly is 40–125 per million. The diagnosis of acromegaly is often delayed due to deficits in recognizing the signs of the disease. It is not known how many subjects with increased IGF‐1 levels have acromegaly. We aimed to assess the prevalence of acromegaly in primary care by screening for elevated IGF‐1 levels. Design A cross‐sectional, epidemiological study (the DETECT study). Patients A total of 6773 unselected adult primary care patients were included. Measurements We measured IGF‐1 in all patients and recommended further endocrine evaluation in all patients with elevated IGF‐1 levels (> 2 age‐dependent SDS). Results Of 125 patients with elevated IGF‐1 levels, 76 patients had indeterminate results and acromegaly could be excluded in 42 patients. One patient had known florid acromegaly. Two patients had newly diagnosed acromegaly and pituitary adenomas. Four patients had biochemical acromegaly but refused further diagnostics. This corresponds to a prevalence of 1034 per million patients. Conclusions Our study shows a high prevalence of undiagnosed acromegaly in primary care. These results imply that acromegaly is underdiagnosed and stress the importance of detecting acromegaly.
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We present a case of acromegaly with normal growth hormone levels. The patient had markedly elevated IGF-1 and a pituitary microadenoma. He refused all modalities of treatment, and over a span of 30 years the signs and symptoms of acromegaly progressed. This case illustrates the shortcomings of growth hormone–based parameters in the diagnosis of acromegaly and the clinical importance of prolonged elevation of IGF-1. The literature on the diagnostic criteria for acromegaly and on cases of acromegaly without a significant growth hormone elevation is reviewed.
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Acromegaly is a rare disorder caused by autonomous oversecretion of growth hormone mostly by pituitary adenoma. Untreated acromegaly leads to significantly increased morbidity and mortality and impaired quality of life. Early diagnosis and treatment is therefore essential for improvement of patients prognosis and management of acromegaly should be concentrated in specialized centres. Present article summarizes current view on diagnosis and treatment of acromegaly.
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Abstract Making a diagnosis Which patients should be tested for acromegaly Which diagnostic tests are used to make a diagnosis of acromegaly What are the common co-morbidities of a patient with acromegaly Treatment options Describe the advantages and disadvantages of medical management of acromegaly Describe the advantages and disadvantages of surgical management of acromegaly Describe the advantages and disadvantages of radiotherapy to manage acromegaly
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History of Acromegaly and Gigantism. The Pituitary Gland: Normal Growth Hormone & Insulin-like Growth Factor-1 Secretion. Acromegaly: Epidemiology, Pathology & Complications. Diagnosis of Acromegaly. The Management of Acromegaly: Surgery. The Management of Acromegaly: Somatostatin Analogs. The Management of Acromegaly: Growth Hormone Receptor Antagonist. The Management of Acromegaly: Dopamine Agonists. The Management of Acromegaly: Radiotherapy
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