Clinical-biochemical correlations in acromegaly at diagnosis and the real prevalence of biochemically discordant disease.
OBJECTIVE
To analyze clinical-biochemical correlations in newly diagnosed acromegaly, focusing in particular on patients with discrepant parameters.


METHODS
Retrospective study.


METHODS
Data from 164 patients with acromegaly seen between 1995 and 2003. Patients were reviewed for the presence of headaches, arthralgias, hypertension, menstrual abnormalities, impotence, glucose intolerance or diabetes. Biochemical evaluation consisted of age- and gender-adjusted IGF-I levels and glucose-suppressed GH.


RESULTS
Magnetic resonance imaging (MRI) revealed macroadenoma in 127 patients and microadenoma in 37. Patients with macroadenomas were younger than those with microadenomas and the disease was more frequent in females. Excluding acral enlargement, which was present in all the patients, the most commonly reported complaints were headaches (66%) and arthralgias (52%). Hypertension was present in 37% of patients, whereas the prevalence of glucose intolerance and diabetes was 27 and 32%, respectively. Hyperprolactinemia was present in 20% of patients with microadenomas and in 40% of patients with macroadenomas. Hypogonadism was demonstrated in more than half of the patients and was not related to tumor size or prolactin level. Of all the clinical and metabolic abnormalities of acromegaly, only the presence of diabetes correlated with both basal and nadir post-glucose GH levels. Only 4 patients (2.4%) had glucose-suppressed GH values of <1 ng/ml in the presence of clinical evidence of acromegaly, an elevated IGF-I level and a pituitary adenoma on MRI.


CONCLUSIONS
Clinical features of acromegaly correlate poorly with indices of biochemical activity. The prevalence of biochemically discordant acromegaly is considerably lower than recently reported.
Mercado
Moisés
M
Endocrinology Section and Experimental Endocrinology Unit, Department of Neurosurgery (GG), Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico. mmercadoa@yahoo.com
Espinosa de los Monteros
Ana Laura
AL
Sosa
Ernesto
E
Cheng
Sonia
S
Mendoza
Victoria
V
Hernández
Irma
I
Sandoval
Carolina
C
Guinto
Gerardo
G
Molina
Mario
M
D000172:Acromegaly / Q000150:complications* / Q000453:epidemiology / Q000378:metabolism*; D000236:Adenoma / Q000473:pathology; D000328:Adult; D000368:Aged; D018771:Arthralgia / Q000453:epidemiology / Q000209:etiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D018149:Glucose Intolerance; D006261:Headache / Q000453:epidemiology / Q000209:etiology; D019382:Human Growth Hormone / Q000097:blood; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000209:etiology; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008055:Lipids / Q000097:blood; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010907:Pituitary Hormones / Q000172:deficiency; D010911:Pituitary Neoplasms / Q000473:pathology; D012189:Retrospective Studies
D008055:Lipids; D010907:Pituitary Hormones; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I