Acromegaly is a rare disorder which the Royal College of Physicians/Society for Endocrinology Guidelines-Pituitary Tumours (1997) suggest should be referred to a specialist centre if suspected. We audited the diagnosis and management of acromegaly in our unit (population covered 250 000) over a 10-year period (19972007). Twelve patients (6 male, 6 female), mean age 48.5 years (2969) were confirmed as having acromegaly. The mean time from referral to first clinic visit was 6.25 days (119).
Investigations: All had basal pituitary function testing including growth hormone and IGF-1. Ten had oral glucose tolerance tests measuring growth hormone (omitted in one because of type 1 diabetes and the other due to urgent surgical intervention). Short Synacthen tests were performed in five patients with equivocal 0900 h cortisol levels. Eleven patients underwent pituitary MR scanning and one CT (MR precluded by cardiac pacemaker).
Mean time from first clinic visit to full diagnosis (including scanning) 3.2 weeks (17).
Management: Eight patients underwent surgery, 2 declined and 2 await surgery. Surgery was curative in 5 patients (macroadenomas) all remaining eupituitary. Those not cured (1 micro, 2 macroadenomas) are treated with depot somatostatin (2), depot somatostatin plus pegvisomant (1) and cabergoline (1).
The non-surgical intervention patients (macroadenomas) are receiving depot somatostatin (1 post radiotherapy).
All surgical patients underwent post operative pituitary function testing at 6 weeks and all patients remain under regular follow-up in our dedicated pituitary clinic. These results show that acromegaly can be efficiently diagnosed and managed in a fairly geographically remote district general hospital. It is most convenient for our patients that once diagnosed they are accepted directly for surgery by our tertiary referral centre with local follow up.