title: Emerging trends in the diagnosis and treatment of acromegaly in Canada.
abstract: OBJECTIVE
  To evaluate demographic data and quality of care of patients with acromegaly in Canada and their evolution over time and secondly, to evaluate predictors of co-morbidities and treatment outcomes.
  
  
  METHODS
  Retrospective analyses of clinical, biochemical and treatment outcome data of 649 patients with acromegaly (males: 50·7%) followed from 1980 to 2010 (mean 10·2 years, SD 13·7) in eight tertiary care centres from six Canadian provinces.
  
  
  RESULTS
  In comparison to 1980-1994, the number of patients referred with acromegaly in the last 15 years was higher with female preponderance (52·8% vs 41·4%, P = 0·01) and an older age at diagnosis (46·4 ± 14 vs 41·3 ± 12 years, P < 0·0001). Diabetes was present in 28%, hypertension in 37% and sleep apnoea in 33% of cases. Pretreatment IGF-1 levels, but not GH levels were significant predictors of diabetes (P = 0·0002) and hypertension (P < 0·0001). Eighty-nine per cent of patients underwent pituitary surgery, 64·5% had medical therapy and 22% received radiotherapy. Radiotherapy was less utilized in the past 15 years (16% vs 45%, P < 0·0001). Multimodal therapy achieved remission or control of acromegaly in 70% of patients. Patients in remission or disease control had lower initial random GH (P = 0·04) and IGF-1 levels (P < 0·0001). Hypopituitarism was present in 23% of patients and cancer in 8·5%.
  
  
  CONCLUSIONS
  There was an increase over time of referral for acromegaly management with female predilection. Initial higher IGF-1, but not GH levels, were predictive of co-morbidities and persistent active disease after treatment. Disease remission or control was attained in 70% of patients utilizing multimodal therapy.
authors.affiliation: CHUM, University of Montreal, Montreal, QC, Canada.
authors.forename: Sophie
authors.initials: S
authors.lastname: Vallette
authors.forename: Shereen
authors.initials: S
authors.lastname: Ezzat
authors.forename: Constance
authors.initials: C
authors.lastname: Chik
authors.forename: Ehud
authors.initials: E
authors.lastname: Ur
authors.forename: Syed Ali
authors.initials: SA
authors.lastname: Imran
authors.forename: Stan
authors.initials: S
authors.lastname: Van Uum
authors.forename: Juan
authors.initials: J
authors.lastname: Rivera
authors.forename: Gudrun
authors.initials: G
authors.lastname: Caspar-Bell
authors.forename: Omar
authors.initials: O
authors.lastname: Serri
mesh_terms: D000172:Acromegaly / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D000328:Adult; D002170:Canada / Q000453:epidemiology; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012189:Retrospective Studies; D012891:Sleep Apnea Syndromes / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D007334:Insulin-Like Growth Factor I