Prevalence of acromegaly in patients with symptoms of sleep apnea

Abstract

Acromegaly is a rare disease with nonspecific symptoms with acral enlargement being almost universally present at diagnosis. The estimated prevalence is 40–125 cases/million but targeted universal screening studies have found a higher prevalence (about 10 fold). The aim of the ACROSAHS study was to investigate the prevalence of acromegaly and acromegaly comorbidities in patients with sleep apnea symptoms and acral enlargement. ACROSAHS was a Spanish prospective non-interventional epidemiological study in 13 Hospital sleep referral units. Facial and acral enlargement symptoms including: ring size and shoe size increase, tongue, lips and jaws enlargement, paresthesia or carpal tunnel syndrome and widening of tooth spaces, as well as other typical acromegaly comorbidities were recorded with a self-administered questionnaire of patients who attended a first visit for sleep apnea symptoms between 09/2013 and 07/2014. Serum insulin-like growth factor type 1 (IGF1) was measured in patients with ≥1 acral symptom to determine the prevalence of acromegaly. Of the 1557 patients enrolled, 1477 with complete data (72% male) were analyzed. 530 patients (36%) reported at least 1 acral enlargement symptom and were tested for IGF-1, 41 were above range, persisted in 7, and among those, 2 cases of acromegaly were diagnosed (prevalence of at least 1.35 cases/1000). Overall, 1019 patients (69%) had ≥2 acromegaly symptoms and should have been screened according to guidelines; moreover 373 patients (25%) had ≥1 symptom of acral enlargement plus ≥3 other acromegaly symptoms. In conclusion, in patients with sleep apnea symptoms and acral enlargement, we found an acromegaly prevalence of at least 1.35 cases per 1000 and a high prevalence of typical acromegaly symptoms. It is important that sleep specialists are aware of acromegaly symptoms to aid with acromegaly diagnosis.

Updates in Diagnosis and Treatment of Acromegaly

“…However, screening may also be considered in patients with several medical conditions known to be associated with acromegaly such as type 2 diabetes mellitus, carpal tunnel syndrome, debilitating arthritis, hypertension and sleep apnoea. 10 – 12 Awareness of these comorbidities is critical for early detection of acromegaly.…”

Prevalence of Sleep-Related Disordered Breathing among Acromegaly Patients and its Correlation to Cephalometric Parameters: An Indian Perspective

“…These results are supported by the observations by Castellani et al, 16 who showed higher uvula thickness and tongue length in acromegaly patients with OSA compared with those without OSA. On the contrary, van Haute et al 3 and Sesmilo et al 17 showed no correlation between severity of OSA and cephalometric parameters. The differences could be attributed to variations in image acquisition and interpretation in these small cohorts.…”

“…The mode of imaging used was also different in the various studies. van Haute et al 3 and Castellani et al 16 used MRI for image acquisition, while Ip et al and Parolin et al 8,18 and Sesmilo et al 17 used computed tomography and teleradiography, respectively. This is the first data on acromegaly and SRBD among Indian subjects although there are several limitations.…”

Malaysian Consensus Statement for the Diagnosis and Management of Acromegaly

“…The most common complaints bringing patients with acromegaly to consult their primary care doctors, that lead to further tests to confirm diagnosis are headache and acral enlargement. 14 The latter feature usually comprises of lower jaw enlargement and protrusion (prognathism) with dental malocclusion, overbite and interdental separation 15 and, increasing ring and shoe size. 10 , 16 …”