Clinical and epidemiologic features of acromegaly in the Republic of Uzbekistan
Zamira Khalimova, Adliya Kholikova, Yulduz Urmanova, Dinara Alieva, Gulchekhra Narimova, Shokhsanam Safarova, Khurshida Nasirova & Gulrukh Alimukhamedova
Aim of the research: To study clinical and epidemiologic features of acromegaly in the Republic of Uzbekistan.
Patients and methods: We observed acromegalic patients registered from 2007 to 2009 who are dispensarized in the regions of the country. Of the 369 patients 143 were males (38.7%) and 226 females (61.3%). Mean age of the patients was 42.6 years-old. Duration of the disease varied from 1 to 31 years.
Results: According to the register data by the end of 2009 there 369 patients with acromegaly were registered of which 143 men (38.7%) and 226 women (61.3%). Morbidity in acromegaly constitutes 1.36 cases per 100 000. Because of uneven prevalence of acromegaly we divided regions according to low, mild and high prevalence. Regions with high prevalence of 2.0 and higher per 100 000: Tashkent (2.6) and Tashkent region (2.0) and Djizak region (2.3); 2) regions with mild prevalence of 1.0 to 2.0: Republic of Karakalpakstan (1.06), Bukhara region (1.08), Syrdaria region (1.4), Navoi region (1.9), Khorezm region (1.7), Namangan region (1.6), Fergana region (1.8). Regions with low prevalence of 1.0 and lower: Samarkand region (0.8), Andijan (0.8), Kashkadarya (0.5) and Surhadarya (0.9).
Mean age of patients was 42.6 years. Duration of the disease varied from 1 to 31 years. Age and sex distribution of patients with acromegaly showed the morbidity prevalence in women and cases growth beginning from 30 to 44 years-old (28.9%) with the peak in 4559 years of age (39.7%) and by the age of 60 years it constitutes similar numbers as in 1629 years-old (12.9%). More than a half of patients did not associate the beginning of the adenoma growth with any causes and factors. Meanwhile in 15.7% of patients disease begun after psycho trauma and stress. History analysis also revealed that viral infection and inflammatory brain disorders in 52 patients (14%) contributed to acromegaly development. Forty-six female patients (12.5%) noticed disease development with pregnancy whereas brain trauma and family history associated with adenoma growth in 32 patients (8.7%) and 19 patients (5.1%) respectively. Thus, acromegaly has subtle beginning associated with neuroviral infections, psycho trauma and pregnancy. The most common symptoms were changes in appearance such as nose, fingers, feet enlargement in 94.8% of patients and headaches (81.8%), perspirations (80%), face and hands edema (85.9%), weakness and work ability decrease (81.8%). Additionally, 70.7% of women had dysmenorrhea or amenorrhea.
Conclusions: Acromegaly morbidity in the Republic of Uzbekistan constitutes 1.3 cases per 100 000 and has uneven distribution in the regions of the country. High prevalence revealed in Tashkent (2.6), Djzak rgion (2.3) and Tashkent region (2.0). Peak age of acromegalic patients was 4559 years (39.7%). Analysis of contribution factors showed that the manifestation of the disease was associated with psycho trauma and stress (15.7%), neuroviral infections (14%), pregnancy (12.5%) and brain trauma (8.7%). Moreover the first symptom of acromegaly can be arterial hypertension (57.9%), headaches (81.8%), dysmenorrhea (70.7%), lactorrhea (39.6%), hypothyroidism (62.3%) and IGT and diabetes (52.3%).