Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Riyadh, Saudi Arabia.
Faculty of Medicine, King Saud Bin Abdul Aziz University of Health Sciences, Riyadh, Saudi Arabia.
Hormones (Athens). 2018 Sep;17(3):373-381. doi: 10.1007/s42000-018-0045-1. Epub 2018 Jul 3.
Worldwide variations exist in the diagnosis and management of patients with acromegaly. For such a rare condition, the knowledge and perception of physicians would most likely direct the care of patients. However, the adherence of physicians in non-Western regions to guidelines for the diagnosis and management of acromegaly has not been previously ascertained.
An online survey was conducted to assess the perceptions and practice of physicians regarding acromegaly diagnosis and management as per international guidelines. An electronic questionnaire containing key questions was mailed, initially to physicians in Saudi Arabia (KSA) and later to other countries in the Middle East and North Africa (MENA) region. Additional questions were included to ensure the relevance of the respondents' replies. The responses were captured and summarized anonymously. Descriptive comparisons were made with two similar international and national surveys from other regions.
Two hundred forty-seven doctors responded to the survey. Of these, 155 (64.5%) fulfilled the inclusion criteria and, in particular, confirmed having treated acromegaly patients in the previous 12 months, and they constituted the basis of this study. The three most common referring specialties for patients were internists (44; 28.4%), neurosurgeons (46; 29.6%), and family medicine physicians (42; 27.1%), respectively. The combination of growth hormone (GH) nadir during the oral glucose tolerance test (OGTT) and elevated insulin-like growth factor-1 (IGF-1) levels was used by 99 physicians (63.9%) to diagnose acromegaly. The main determinant for treatment choice was tumor mass characteristics confirmed by 117 respondents (75.5%) with neurosurgery as first treatment choice confirmed by 124 respondents (80%). Combined measurement of IGF-1 and GH levels after OGTT at 3 months after surgery was the most widely used criterion for assessment of surgical outcomes, confirmed by 82 physicians (52.9%). The biggest barriers to optimal management of acromegaly as perceived by 38.1% and 35.5% of the respondents were high cost of medications and lack of physicians' awareness, respectively.
The majority of the surveyed physicians reported variable adherence to the international acromegaly guidelines. Clearly, higher awareness is needed among physicians for early diagnosis and timely referral for specialist management.
全世界在肢端肥大症患者的诊断和治疗方面存在差异。对于这种罕见疾病，医生的知识和认知很可能会指导患者的治疗。然而，非西方地区的医生是否遵循肢端肥大症的诊断和治疗指南，尚未得到证实。
我们进行了一项在线调查，以评估医生根据国际指南对肢端肥大症诊断和治疗的看法和实践。我们最初向沙特阿拉伯（KSA）的医生发送了包含关键问题的电子问卷，然后向中东和北非（MENA）地区的其他国家发送了问卷。我们还增加了一些问题以确保回复者的回答具有相关性。我们匿名收集并总结了回复。我们将这些回复与来自其他地区的两项类似的国际和国家调查进行了描述性比较。
有 247 名医生对调查做出了回应。其中，有 155 名（64.5%）满足纳入标准，特别是在过去 12 个月内治疗过肢端肥大症患者，他们是本研究的基础。患者最常转介的三个科室是内科医生（44 名；28.4%）、神经外科医生（46 名；29.6%）和家庭医生（42 名；27.1%）。有 99 名医生（63.9%）使用口服葡萄糖耐量试验（OGTT）时的生长激素（GH）最低点和升高的胰岛素样生长因子-1（IGF-1）水平来诊断肢端肥大症。有 117 名医生（75.5%）认为肿瘤大小特征是治疗选择的主要决定因素，有 124 名医生（80%）认为神经外科是首选治疗方法。术后 3 个月时 OGTT 后 IGF-1 和 GH 水平的联合测量是评估手术结果最广泛使用的标准，有 82 名医生（52.9%）对此表示认可。有 38.1%和 35.5%的受访者认为药物费用高和医生意识不足是肢端肥大症最佳管理的最大障碍。
大多数接受调查的医生报告说，他们对肢端肥大症的国际指南的遵守情况存在差异。显然，需要提高医生对早期诊断和及时转介给专科医生管理的认识。
