Aims: Endocrine Society (ES) acromegaly guidelines (2014) addressed complication screening. Uncontrolled acromegaly is associated with elevated cardiovascular mortality due to risk factors including hypertension (HT), diabetes mellitus (DM), obstructive sleep apnoea (OSA), and with an increased risk of colorectal cancer and polyps among other types of neoplasias. We audited our clinical practice with regards to acromegaly complication screening.
Methods: Retrospective study of all patients with acromegaly under active follow up in a teaching hospital. Data were collected from paper and electronic records (2009 onwards). Rates of complication screening were compared before and after the publication of the guidelines (2014).
Results: Fifty-one patients were included, 61% female. Mean age 58.9±16.5 years. Mean age at diagnosis 43.4±16.9 years. Median of follow up of 13 years, IQR:15.5. All patients were screened for HT and DM at diagnosis, and 93% and 98% during the last year respectively. Currently 19 (37%) of patients have HT and 13 (26%) have DM, impaired fasting glucose/impaired glucose tolerance. See Table 1 for comparison of complication screening pre and post guidelines. Twenty-six (51%) patients have had a colonoscopy done, median age at colonoscopy of 54 years, IQR:19.7; this was done in a median of 7 years after diagnosis IQR:9.7. Twenty (77%) had a normal result, 6 (23%) were reported to have polyps. 5 out of 6 patients referred to the sleep apnoea clinic were diagnosed with OSA.
Comments: The ES guidelines have enhanced our awareness of screening for complications in patients with acromegaly. Referral for colonoscopy and screening for OSA has increased, but there is scope for improvement for thyroid examination. The ES guidelines differ from British Society of Gastroenterology (2009) guidelines in recommending colonoscopy screening commence at diagnosis rather than at age 40.
|Before guidelines||After guidelines|
|Colonoscopy had or referred||33%||84%|
|Enquired regarding snoring||40%||64%|
|OSA-Epworth score completed||2%||60%|