Gender differences in acromegaly at diagnosis

Denis C; Daly A; Natchev E; Maione L; Neggers SJCMM; Brue T; Colao A; Delemer B; Hulting AL; Hana V; Gatto F; Jaffrain-Réa ML; Stalla GK; Khyzhnyak O; Carvalho D; Fajardo-Montañana C; Beckers A; Petrossians P

doi:10.1530/endoabs.106.007

This study aims to identify sex differences and similarities in acromegaly and its comorbidities at diagnosis. Indeed, awareness regarding the sex related approach of acromegaly is increasing [1,2]. We used the LAS database [3], a relational database containing clinical data, comorbidities, and treatments of 3360 patients across 11 countries in EuropeThe study population included more females (54.4%) than males (45.6%). Median age of diagnosis was earlier for men (43.6) than for women (46.3, P < 0.001). First symptoms appeared in average 2 years later for women (34.4) than for men (32.7, P = 0.07). Moreover, acromegaly progressed before diagnosis for a longer time in females (9 years) than in males (8 years, P = 0.04). With time, there was a progressive increase in the M/F sex ratio from 0.65 in the 70’s to 1.1 in the 2010’s. At diagnosis, tumors were bigger in males (15 mm) than in females (14mm, P < 0.01). There was no difference in the rate of chiasmatic compression. Cavernous sinus invasion seemed more frequent in males (41.2%) than in females (37.3%, P = 0,05). Signs and symptoms that led to diagnosis were not significantly different between the sexes. For both sex, in most cases, dysmorphic features were the first signs that led the physician to think about acromegaly. Carpal tunnel syndrome prevalence was close in females (20.1) and in men (19.7 %, P = 0.55), and was more frequent for patients who were older than 50. Likewise, thyroid nodules were significantly more common in females (39.9%) than in males (27.3%, P < 0.001). In contrast, colonic polyps were more frequent in males (16.8%) than females (9.3%, P < 0.01). Regarding cardiovascular comorbidities, there were no significant differences about hypertension, arrythmia, and ischemic cardiopathy between females and males. In contrast, history of myocardial infarction was more frequently observed in males (4.8%) than females (1.3%, P < 0.001). In conclusion, the various comorbidities observed in acromegaly differ depending on the sexes. Tumors were bigger in males than in females. Median age of diagnosis was earlier for males than for females and the delay of diagnosis was longer for females than for males. Thyroid nodules and carpal tunnel syndrome are more significantly common in females while colonic polyps and myocardial infarctions were more frequently observed in males. Certain comorbidities such as hypertension, arrythmia, and ischemic cardiopathy do not differ between the sexes.

References: [1] MANAGEMENT OF ENDOCRINE DISEASE: Does gender matter in the management of acromegaly? Lexnders NF, McCormack AI, Ho KKY. Eur J Endocrinol. 2020 May;182(5):R67-R82.

[2] Sex difference in patients with controlled acromegaly-A multicentre survey. Dal et al. Clin Endocrinol(Oxf). 2023 Jan;98(1):74-81.

[3] Acromegaly at diagnosis in 3173 patients from the Liège Acromegaly Survey (LAS) Database. Petrossians P, Daly AF, Becker A et al. Endocr Relat Cancer. 2017 Oct;24(10):505-518.

Endocrine Abstracts

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