Emerging trends in the diagnosis and treatment of acromegaly in Canada

Objective To evaluate demographic data and quality of care of patients with acromegaly in Canada and their evolution over time and secondly, to evaluate predictors of co-morbidities and treatment outcomes. Design and patients Retrospective analyses of clinical, biochemical and treatment outcome data of 649 patients with acromegaly (males: 50 center dot 7%) followed from 1980 to 2010 (mean 10 center dot 2years, SD 13 center dot 7) in eight tertiary care centres from six Canadian provinces. Results In comparison to 1980-1994, the number of patients referred with acromegaly in the last 15years was higher with female preponderance (52 center dot 8% vs 41 center dot 4%, P=0 center dot 01) and an older age at diagnosis (46 center dot 4 +/- 14 vs 41 center dot 3 +/- 12years, P<0 center dot 0001). Diabetes was present in 28%, hypertension in 37% and sleep apnoea in 33% of cases. Pretreatment IGF-1 levels, but not GH levels were significant predictors of diabetes (P=0 center dot 0002) and hypertension (P<0 center dot 0001). Eighty-nine per cent of patients underwent pituitary surgery, 64 center dot 5% had medical therapy and 22% received radiotherapy. Radiotherapy was less utilized in the past 15years (16% vs 45%, P<0 center dot 0001). Multimodal therapy achieved remission or control of acromegaly in 70% of patients. Patients in remission or disease control had lower initial random GH (P=0 center dot 04) and IGF-1 levels (P<0 center dot 0001). Hypopituitarism was present in 23% of patients and cancer in 8 center dot 5%. Conclusions There was an increase over time of referral for acromegaly management with female predilection. Initial higher IGF-1, but not GH levels, were predictive of co-morbidities and persistent active disease after treatment. Disease remission or control was attained in 70% of patients utilizing multimodal therapy.