title: Demographic factors and the presence of comorbidities do not promote early detection of Cushing's disease and acromegaly.
abstract: OBJECTIVE
  The aim of the study was to analyze the time-to-diagnosis interval in patients with Cushing's disease (CD) and acromegaly (AC), to assess factors that promote early disease detection and to investigate the medical fields diagnosing the pathologies.
  
  
  METHODS
  33 CD and 52 AC patients operated over 10 years received a self-designed disease-related questionnaire. Data about symptoms and their duration prior to diagnosis, education level, age, gender and place of residence (i. e. rural vs. urban, size of the city) were collected.
  
  
  RESULTS
  The mean time-to-diagnosis interval was 6.0 years in CD and 5.8 years in AC patients. The vast majority of 67% of all investigated patients was diagnosed after they changed their primary health care provider or during a hospital stay owing to comorbidities caused by their underlying disease. Only 33% of all cases were diagnosed by their primary physician. In both groups neither gender, age, place of residence, education level, typical comorbidities (e. g. hypertension or diabetes) nor distinctive symptoms and bodily changes of the underlying disease (e. g. prognathism, acral enlargement, weight gain, buffalo hump) were significant factors promoting early detection.
  
  
  CONCLUSIONS
  Apparently, patient-related factors do not affect the time-to-diagnosis interval, but rather the change of the primary health care provider. Knowledge of the disease among physicians is prerequisite to early detection. Due to the deleterious sequelae of delayed diagnosis, information programmes in the medical community are of paramount importance. Institution of screening programmes should be evaluated.
authors.affiliation: Department of Neurosurgery, University of Tuebingen, Germany. tsambika.psaras@med.uni-tuebingen.de
authors.forename: T
authors.initials: T
authors.lastname: Psaras
authors.forename: M
authors.initials: M
authors.lastname: Milian
authors.forename: V
authors.initials: V
authors.lastname: Hattermann
authors.forename: T
authors.initials: T
authors.lastname: Freiman
authors.forename: B
authors.initials: B
authors.lastname: Gallwitz
authors.forename: J
authors.initials: J
authors.lastname: Honegger
mesh_terms: D000172:Acromegaly / Q000150:complications / Q000175:diagnosis*; D000367:Age Factors; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D042241:Early Diagnosis; D006801:Humans; D006973:Hypertension / Q000150:complications; D047748:Pituitary ACTH Hypersecretion / Q000150:complications / Q000175:diagnosis*; D012737:Sex Factors; D013997:Time Factors