Demographic factors and the presence of comorbidities do not promote early detection of Cushing's disease and acromegaly
Tsambika Psaras, Monika Milian & Juergen Honegger
Objective: The aim of the study was to analyze the time-to-diagnosis interval in patients with Cushings disease (CD) and acromegaly (AC), to assess factors that promote early disease detection and to investigate the medical fields diagnosing the pathologies.
Design: Case-record retrospective study.
Patients: CD and 52 AC patients operated between June 1998 and December 2007.
Measurements: All patients received a self-designed disease-related questionnaire. Data about symptoms and their duration prior to diagnosis, education level, age, gender and place of residence (i.e. rural vs. urban, size of the city) were collected.
Results: The mean time-to-diagnosis interval was 6.0 years in CD and 5.8 years in AC patients. The vast majority of 67% of all investigated patients was diagnosed after they changed their primary health care provider or during a hospital stay owing to comorbidities caused by their underlying disease. Only 33% of all cases were diagnosed by their primary physician. In both groups neither gender, age, place of residence, education level, typical comorbidities (e.g. hypertension or diabetes) nor distinctive symptoms and bodily changes of the underlying disease (e.g. prognathism, acral enlargement, weight gain, buffalo hump) were significant factors promoting early detection.
Conclusions: Apparently, patient-related factors do not affect the time-to-diagnosis interval, but rather the change of the primary health care provider. Knowledge of the disease among physicians is prerequisite to early detection. Due to the deleterious sequelae of delayed diagnosis, information programmes in the medical community are of paramount importance. Institution of screening programmes should be evaluated.