CHUM, University of Montreal, Montreal, QC, Canada.
Clin Endocrinol (Oxf). 2013 Jul;79(1):79-85. doi: 10.1111/cen.12112. Epub 2013 Apr 27.
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.
Retrospective analyses of clinical, biochemical and treatment outcome data of 649 patients with acromegaly (males: 50·7%) followed from 1980 to 2010 (mean 10·2 years, SD 13·7) in eight tertiary care centres from six Canadian provinces.
In comparison to 1980-1994, the number of patients referred with acromegaly in the last 15 years was higher with female preponderance (52·8% vs 41·4%, P = 0·01) and an older age at diagnosis (46·4 ± 14 vs 41·3 ± 12 years, P < 0·0001). 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 = 0·0002) and hypertension (P < 0·0001). Eighty-nine per cent of patients underwent pituitary surgery, 64·5% had medical therapy and 22% received radiotherapy. Radiotherapy was less utilized in the past 15 years (16% vs 45%, P < 0·0001). Multimodal therapy achieved remission or control of acromegaly in 70% of patients. Patients in remission or disease control had lower initial random GH (P = 0·04) and IGF-1 levels (P < 0·0001). Hypopituitarism was present in 23% of patients and cancer in 8·5%.
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.
评估加拿大肢端肥大症患者的人口统计学数据和治疗质量，并评估其随时间的变化情况，其次评估合并症和治疗结果的预测因素。
对来自加拿大六个省份的八个三级保健中心的 649 例肢端肥大症患者（男性：50.7%）的临床、生化和治疗结果数据进行回顾性分析，这些患者从 1980 年至 2010 年（平均随访 10.2 年，标准差 13.7 年）。
与 1980-1994 年相比，过去 15 年中因肢端肥大症就诊的患者数量更多，女性比例更高（52.8%对 41.4%，P=0.01），诊断时年龄更大（46.4±14 岁对 41.3±12 岁，P<0.0001）。28%的患者有糖尿病，37%的患者有高血压，33%的患者有睡眠呼吸暂停。治疗前 IGF-1 水平，但不是 GH 水平是糖尿病（P=0.0002）和高血压（P<0.0001）的显著预测因素。89%的患者接受了垂体手术，64.5%的患者接受了药物治疗，22%的患者接受了放疗。过去 15 年中放疗的使用率较低（16%对 45%，P<0.0001）。多模式治疗使 70%的患者达到缓解或控制肢端肥大症。缓解或疾病控制的患者初始随机 GH（P=0.04）和 IGF-1 水平较低（P<0.0001）。23%的患者有垂体功能减退，8.5%的患者有癌症。
随着时间的推移，肢端肥大症的治疗转诊率呈上升趋势，女性更倾向于接受治疗。初始较高的 IGF-1，但不是 GH 水平，可预测合并症和治疗后持续的活动性疾病。70%的患者通过多模式治疗达到缓解或控制。
