Acromegaly in the North Denmark Region
Author
Finnerup, Susanne
Term
5. Term (Master thesis)
Education
Publication year
2019
Submitted on
2019-01-02
Pages
11
Abstract
Akromegali er en sjælden sygdom med overproduktion af væksthormon og forhøjet IGF-1, som ofte opdages sent. Dette studie undersøgte, om udviklingen i diagnostik har ændret forekomst og sygdomsbillede i Region Nordjylland. Alle patienter diagnosticeret ved Aalborg Universitetshospital blev identificeret via nationale registre (ICD-8/10) og systematisk journalgennemgang; 76 patienter diagnosticeret 1976-2016 indgik. Ved diagnosen blev der indsamlet data om symptomer, IGF-1, GH under oral glukosebelastning, hypofyseadenomstørrelse, alder, køn og bopælskommune; incidens og prævalens blev beregnet og sammenlignet med litteraturen, og geografiske forskelle mellem kommuner blev kortlagt. Prævalensen i 2016 var 94 tilfælde per million indbyggere (108 hvis tilflyttere medregnes). Incidensen steg i 1990’erne med en top på 6,9 per million per år og har siden stabiliseret sig omkring 4 per million per år. Gennemsnitsalderen ved diagnose steg fra slut-30’erne til midt-50’erne, og mænd var ældre end kvinder ved diagnosen. Der sås ingen tydelige ændringer over tid i tumorstørrelse, diagnostisk forsinkelse eller antal kliniske tegn; hyppigste fund var forstørrede hænder/fødder og ansigtsforandringer, og diabetes samt hypertension var almindelige komorbiditeter. Patienter boede oftere i centralt beliggende kommuner, hvor prævalensen i gennemsnit var omkring fire gange højere end i yderområderne. Samlet lå incidens og prævalens i Nordjylland højere end i mange internationale rapporter, og trods bedre diagnostiske værktøjer synes den diagnostiske forsinkelse ikke at være reduceret, hvilket peger på behov for en målrettet indsats især i yderområderne.
Acromegaly is a rare disorder characterized by excess growth hormone and elevated IGF-1, and it is often diagnosed late. This study examined whether advances in diagnostics have altered the epidemiology and clinical presentation in the North Denmark Region. All patients diagnosed at Aalborg University Hospital were identified through national registries (ICD-8/10) and systematic chart review; 76 patients diagnosed between 1976 and 2016 were included. At diagnosis, data on symptoms, IGF-1, growth hormone during an oral glucose tolerance test, pituitary adenoma size, age, sex, and municipality were collected; incidence and prevalence were calculated and compared with the literature, and geographic differences across municipalities were explored. In 2016, prevalence was 94 cases per million inhabitants (108 when including newcomers). Incidence rose in the 1990s, peaking at 6.9 per million per year, and has since stabilized around 4 per million per year. The average age at diagnosis increased from the late 30s to the mid-50s, with men diagnosed at an older age than women. No clear changes over time were seen in tumor size, diagnostic delay, or the number of clinical features; the most frequent findings were enlargement of hands/feet and facial changes, and diabetes and hypertension were common comorbidities. Patients more often resided in centrally located municipalities, where prevalence was on average about four times higher than in peripheral areas. Overall, incidence and prevalence in North Denmark were higher than many international reports, and despite improved diagnostic tools, diagnostic delay appears unchanged, indicating a need for targeted efforts, particularly in peripheral areas.
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