Prevalence of clinical signs, symptoms and comorbidities at diagnosis of acromegaly: a systematic review in accordance with PRISMA guidelines

Tessa N A Slagboom; Christa C van Bunderen; Ralph De Vries; Peter H Bisschop; Madeleine L Drent

doi:10.1007/s11102-023-01322-7

Prevalence of clinical signs, symptoms and comorbidities at diagnosis of acromegaly: a systematic review in accordance with PRISMA guidelines

Pituitary. 2023 Aug;26(4):319-332. doi: 10.1007/s11102-023-01322-7. Epub 2023 May 20.

Authors

Tessa N A Slagboom^{1

2}, Christa C van Bunderen^{3

4}, Ralph De Vries⁵, Peter H Bisschop^{6

7}, Madeleine L Drent^{3

7}

Affiliations

¹ Department of Endocrinology and Metabolism, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands. t.slagboom@amsterdamumc.nl.
² Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands. t.slagboom@amsterdamumc.nl.
³ Department of Endocrinology and Metabolism, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
⁴ Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
⁵ Medical Library, Vrije Universiteit, Amsterdam, The Netherlands.
⁶ Department of Endocrinology and Metabolism, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
⁷ Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands.

Abstract

Objective: Diagnostic delay is high in acromegaly and leads to increased morbidity and mortality. The aim of this study is to systematically assess the most prevalent clinical signs, symptoms and comorbidities of acromegaly at time of diagnosis.

Design: A literature search (in PubMed, Embase and Web of Science) was performed on November 18, 2021, in collaboration with a medical information specialist.

Methods: Prevalence data on (presenting) clinical signs, symptoms and comorbidities at time of diagnosis were extracted and synthesized as weighted mean prevalence. The risk of bias was assessed for each included study using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data.

Results: Risk of bias and heterogeneity was high in the 124 included articles. Clinical signs and symptoms with the highest weighted mean prevalence were: acral enlargement (90%), facial features (65%), oral changes (62%), headache (59%), fatigue/tiredness (53%; including daytime sleepiness: 48%), hyperhidrosis (47%), snoring (46%), skin changes (including oily skin: 37% and thicker skin: 35%), weight gain (36%) and arthralgia (34%). Concerning comorbidities, acromegaly patients more frequently had hypertension, left ventricle hypertrophy, dia/systolic dysfunction, cardiac arrhythmias, (pre)diabetes, dyslipidemia and intestinal polyps- and malignancy than age- and sex matched controls. Noteworthy, cardiovascular comorbidity was lower in more recent studies. Features that most often led to diagnosis of acromegaly were typical physical changes (acral enlargement, facial changes and prognatism), local tumor effects (headache and visual defect), diabetes, thyroid cancer and menstrual disorders.

Conclusion: Acromegaly manifests itself with typical physical changes but also leads to a wide variety of common comorbidities, emphasizing that recognition of a combination of these features is key to establishing the diagnosis.

Keywords: Acromegaly; Comorbidities; Diagnosis; Prevalence; Signs; Symptoms.

Publication types

Systematic Review
Review

MeSH terms

Acromegaly* / diagnosis
Acromegaly* / epidemiology
Comorbidity
Delayed Diagnosis
Diabetes Mellitus*
Headache
Humans
Hypertension*
Prevalence