Epidemiology of acromegaly in Italy
Elena Malchiodi1,2, Maura Arosio1,2, Alberto Borraccino5, Giuseppe Reimondo3,4, Barbara Zaggia3,4, Laura Montefusco1,2, Anna Maria Colao6 & Massimo Terzolo3,4
Aim of this study is to present preliminary epidemiological data on a population of 1512 acromegalic patients attending 22 tertiary centers in Italy from 1980 to 2002. At our knowledge this is the first largescale epidemiological Italian study on acromegaly. Gender was 624 (41.2%) men and 888 (58.8%) women. Mean age at diagnosis was 45±13 years, 43±13 for men and 47±13 for women. Median estimated duration of acromegaly before diagnosis was 74 months (range: 36144). 28% of cases were micro-adenomas and 68.6% macro-adenomas, the lattest being intrasellar in 41.2% of patients. At baseline GH were over 50 μg/liter in 15.7% of patients, between 50 and 2.5 μg/liter in 73.7% and under 2.5 μg/liter in 1%. Data were not available in 9.6% of patients. Two patients had GH nadir during OGTT below 1 μg/liter but elevated IGFI. Pre-treatment IGFI was available in 67.3% patients. Hyperprolactinemia was observed in 251(19%) patients (2/3 of whom women) and TSH hypersecretion in 9 (0.7%). 392 patients (25.9%) had one or more pituitary deficiencies: 4.1% hypoadrenalism, 8.1% hypothyroidism, 16.4% hypogonadism and 0.6% diabetes insipidus. 32.2% of patients presented hypertension, 16.2% diabetes mellitus, both diagnosed at a younger age than in general population and more frequent in women. Surgery represented first treatment in 53% of patients, pharmacological therapy in 45.9% and radiotherapy/radiosurgery in 0.8%. Only 34.3% of subjects underwent just one treatment, other patients had multiple therapies in particular: two treatments in 47.9%, three in 16.4% and four in 1.2%. At the end of the study 932 (62.6%) patients resulted in remission, of whom 399 (43.7%) currently on pharmacological treatment. 61 patients died: the main causes were vascular disease and malignancies. For vascular disease women had a major mortality for cerebral disease (20 versus 4%) while men for cardiac disease (38 versus 28%).