Endocrine Abstracts

Background and Aims: Acromegaly is a rare condition caused by an excessive secretion of growth hormone (GH) and insulin-like growth factor1 (IGF-1), which are responsible for exaggerated somatic growth and distorted proportions. The objective of the current work was to investigate the clinical and demographic features of acromegaly in Mediterranean patients.

Patients and Method: From 1997 to 2021, 29 patients with acromegaly were diagnosed and followed up at the Endocrinology Department of Hedi Chaker University Center, Sfax, Tunisia. We retrospectively reviewed the medical charts of all patients to assess their clinical and demographic characteristics.

Results: We noted a slight male predominance with a sex-ration of 1.07. The mean age at diagnosis was 45.8 ± 12.4 years old. The diagnosis of acromegaly was more delayed in females (male: 44.1 ± 11.2 vs female: 47.7 ± 13.7 years old). Symptoms related to tumoral mass effects such as headache and visual impairment were the leading causes of consultation in 31.0%. Changes in appearance brought only 17.2% of patients who had acromegaly to seek medical care. In 27.6% of cases, patients with dysmorphic features were referred by their physicians to the Endocrinology department for further hormonal assessment. The worsening of some nonspecific symptoms such as snoring (10.3%), glycemic imbalance (6.9%), and secondary amenorrhea (6.9%) led to the diagnosis of acromegaly. The mean weight was 82.5 ± 13.0 kg. The average height was 167.3 ± 11.2 cm (extremes:146-191). The mean BMI was 28.0 ± 7.2 kg/m². Obesity was found in 40.7%. Dysmorphic features were observed in all patients with variable degrees. The dermatologic examination noticed frequently thickening skin (69.0%) and hyperhidrosis (65.5%). A horsely voice was found in 48.3%. Patients with acromegaly reported asthenia, lower back pain, and arthromyalgia in 41.4%, 20.7%, and 10.3%, respectively. The principal general comorbidities associated with this condition were diabetes (34.4%), hypertension (13.7%), and dyslipidemia (10.3%).

Conclusion: Acromegaly is an insidious disease that impacts equally both genders with a prevalence ranging between 2.8 and 13.7 cases per 100,000 people. Clinical manifestations include skeletal and soft tissue deformities, along with cardiorespiratory, neuromuscular, and metabolic disturbances. Most patients are diagnosed at an advanced stage after the onset of tumoral mass effect signs. Better recognition of the clinical landscape of acromegaly by first-line physicians may help in its precocious diagnosis and thus improve its therapeutic outcomes.