Epidemiology, clinical characteristics, outcome, morbidity and mortality in acromegaly based on the Spanish Acromegaly Registry (Registro Espanol de Acromegalia, REA).
OBJECTIVE
To undertake a multicentre epidemiological study reflecting acromegaly in Spain.


METHODS
Voluntary reporting of data on patients with acromegaly to an online database, by the managing physician.


METHODS
Data on demographics, diagnosis, estimated date of initial symptoms and diagnosis, pituitary imaging, visual fields, GH and IGF-I concentrations (requested locally), medical, radiotherapy and neurosurgical treatments, morbidity and mortality were collected.


RESULTS
Data were included for 1219 patients (60.8% women) with a mean age at diagnosis of 45 years (s.d. 14 years). Reporting was maximal in 1997 (2.1 cases per million inhabitants (c.p.m.) per year); prevalence was globally 36 c.p.m., but varied between 15.7 and 75.8 c.p.m. in different regions. Of 1196 pituitary tumours, most were macroadenomas (73%); 81% of these patients underwent surgery, 45% received radiotherapy and 65% were given medical treatment (somatostatin analogues in 68.3% and dopamine agonists in 31.4%). Cures (GH values (basal or after an oral glucose tolerance test) <2 ng/ml, normal IGF-I, or both) were observed in 40.3% after surgery and 28.2% after radiotherapy. Hypertension (39.1%), diabetes mellitus (37.6%), hypopituitarism (25.7%), goitre (22.4%), carpal tunnel syndrome (18.7%) and sleep apnoea (13.2%) were reported as most frequent morbidities; 6.8% of the patients had cancer (breast in 3.1% of the women and colon in 1.2% of the cohort). Fifty-six patients died at a mean age of 60 years (s.d. 14 years), most commonly of a cardiovascular cause (39.4%); mortality was greater in patients given radiotherapy (hazard ratio 2.29; 95% confidence interval 1.03 to 5.08; P=0.026), and in those in whom GH and IGF-I concentrations were never normal (P<0.001).


CONCLUSIONS
This acromegaly registry offers a realistic overview of the epidemiological characteristics, treatment outcome and morbidity of acromegaly in Spain. As active disease and treatment with radiotherapy are associated with an increase in mortality, efforts to control the disease early are desirable.
Department of Endocrinology, Hospital Dos de Maig, Barcelona, Spain.
Antonio
A
Mestron
Susan M
SM
Webb
Ricardo
R
Astorga
Pedro
P
Benito
Miguel
M
Catala
Sonia
S
Gaztambide
Jose-Manuel
JM
Gomez
Irene
I
Halperin
Tomas
T
Lucas-Morante
Basilio
B
Moreno
Gabriel
G
Obiols
Pedro
P
de Pablos
Concha
C
Paramo
Antonio
A
Pico
Elena
E
Torres
Cesar
C
Varela
Jose-Antonio
JA
Vazquez
Juana
J
Zamora
Merce
M
Albareda
Montserrat
M
Gilabert
D000172:Acromegaly / Q000401:mortality* / Q000503:physiopathology* / Q000601:surgery; D000328:Adult; D005260:Female; D013006:Growth Hormone / Q000378:metabolism; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D000091402:Prohibitins; D012042:Registries; D013030:Spain / Q000453:epidemiology
C000717331:PHB2 protein, human; D000091402:Prohibitins; D013006:Growth Hormone