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Targeted acromegaly screening needed to improve outcomes, reduce complications
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A targeted screening program to detect acromegaly in at-risk patients is feasible and could reduce disease complications and health care costs, according to a retrospective literature review.
“Since many of the symptoms of acromegaly are nonspecific and similar to other more common diseases, diagnosis is often missed or delayed by 5 to 10 years from the onset of symptoms,” Karina Danilowicz, MD, PhD, of the division of endocrinology at Hospital de Clínicas, University of Buenos Aires, Argentina, and colleagues wrote. “This delay is also partly due to the fact that the clinical effects of excess [growth hormone] occur insidiously over time. This provides a major opportunity for earlier detection.”
The researchers noted that patients often visit several health care providers before a diagnosis of acromegaly, a disease that typically presents with physiognomic alterations and growth of the acral parts.
“Surprisingly, the features present at clinical diagnosis have not changed between 1981 and 2006, and so it is clear the acromegaly remains underdiagnosed and under-recognized,” the researchers wrote. “Increasing awareness of these typical early features may help to identify patients at risk, rather than addressing comorbidities, which usually appear later, are not always present and are rarely seen in the absence of these phenotypes.”
First steps to implement a screening program should include the design of a simple detection program based on offering free insulin-like growth factor-I measurements for patients with warning signs and undertaking a pilot study (single or multicenter) in a given country before extending the program, the researchers wrote, adding that a questionnaire that evaluates the enlargement of extremities could assist with the screening process.
Any screening program should include a plan to increase awareness of early signs of the disease among primary care physicians and relevant specialists, as well as the general public. A referral process for patients deemed to be at high risk would also need to be developed and implemented.
Mass screening would be “costly and unfeasible,” according to researchers, but targeted screening may be more acceptable, as it could decrease costs associated with comorbidities.
“The earlier diagnosis and treatment that could be provided by the success of this type of screening program could lead to improved outcomes and, hopefully, cost savings in the long term due to fewer and less severe complications that tend to manifest over time in delayed diagnosis,” the researchers wrote. – by Regina Schaffer
Disclosure: Ipsen funded this study.
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