<scp>ACROSCORE</scp>: a new and simple tool for the diagnosis of acromegaly, a rare and underdiagnosed disease

Prencipe, Nunzia; Floriani, Irene; Guaraldi, Federica; Giacomo, Stellina V. Di; Cannavò, Salvatore; Arnaldi, Giorgio; Berton, Alessandro Maria; Torri, Valter; Spinello, Maurizio; Arvat, Emanuela; Ghigo, Ezio; Grottoli, Silvia

doi:10.1111/cen.12959

Cited by 31 publications

(40 citation statements)

References 27 publications

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“…Although using MCA to identify sign-and-symptom associations at diagnosis was unsuccessful in these analyses, a recent case-control study found strong associations between manifestations and diagnosis using univariate and multivariate regression models, despite the inclusion of fewer patients [ 27 ]. Nevertheless, our study highlights the difficulty in identifying manifestations, and clusters of these, that would raise acromegaly awareness in physicians and support clinical screening for early acromegaly diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Signs and symptoms of acromegaly at diagnosis: the physician’s and the patient’s perspectives in the ACRO-POLIS study

Caron

Brue

Raverot³

et al. 2018

Endocrine

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PurposeAcromegaly is characterized by a broad range of manifestations. Early diagnosis is key to treatment success, but is often delayed as symptomatology overlaps with common disorders. We investigated sign-and-symptom associations, demographics, and clinical characteristics at acromegaly diagnosis.MethodsObservational, cross-sectional, multicenter non-interventional study conducted at 25 hospital departments in France that treat acromegaly (ClinicalTrials.gov: NCT02012127). Adults diagnosed with acromegaly < 5 years were enrolled. Demographic and clinical data were obtained from medical reports and patient questionnaires. Sign-and-symptom associations were assessed by multiple correspondence analysis (MCA).ResultsOverall, 472 patients were included in the analyses. MCA was unsuccessful in identifying sign-and-symptom associations at diagnosis. Endocrinologists (29.5% patients) and other clinical specialists (37.2% patients) were commonly first to suspect acromegaly. Morphologic manifestations (83.7–87.9% patients), snoring syndrome (81.4% patients), and asthenia (79.2% patients) were frequently present at diagnosis; differences were found between sexes for specific manifestations. Rates of discrepancy between patient- and physician-reported manifestations were highest for functional signs. Earliest manifestations prior to diagnosis, according to how they were detected, were enlarged hands and feet (6.4 ± 6.8 and 6.2 ± 6.9 years, functional signs), hypertension (6.6 ± 7.5 years, complementary examination) and carpal/cubital tunnel syndrome (5.7 ± 6.7 years, functional signs with complementary examination).ConclusionsResults confirm the broad range of manifestations at diagnosis and delay in recognizing the disease. We identified early manifestations and sex differences that may aid physicians in diagnosing acromegaly. Discrepancy rates suggest physicians should obtain the patient’s perspective and seek functional signs during diagnosis.

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Section: Discussionmentioning

confidence: 99%

Signs and symptoms of acromegaly at diagnosis: the physician’s and the patient’s perspectives in the ACRO-POLIS study

Caron

Brue

Raverot³

et al. 2018

Endocrine

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“… 8 A scoring system called “ACROSCORE” has been used to investigate and confirm acromegaly in the very early stages ( Figure 1 ). 28 …”

Section: Associated Comorbiditiesmentioning

confidence: 99%

Acromegaly: a challenging condition to diagnose

AlDallal

2018

IJGM

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Acromegaly is an uncommon, chronic disease, characterized by hypersecretion of a pituitary growth hormone by somatotroph adenomas, along with increased levels of insulin-like growth factor-1. Although acromegaly presents a wide array of clinical manifestations, the salient symptoms include acral and soft tissue enlargement, joint pain, heart and respiratory failure, diabetes mellitus, and hypertension, leading to increased morbidity and mortality. Hence, early diagnosis of the disease is critical to enhance life expectancy and quality of life. New approaches are being developed for diagnosis and surveillance (both screening and follow-up), including sensitive biochemical assays and the use of MRI to visualize extremely small tumors, and are helpful in the early diagnosis of acromegaly, subsequent treatment, and disease control. This mini-review summarizes the most common and effective tools used in the diagnosis of acromegaly.

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“…For example, studies have shown that around 40 % of patients are diagnosed by internists or family physicians, and also by ophthalmologists (if they have changes in vision), dentists (orofacial changes, separation of teeth, and malocclusion), gynecologists (menstrual irregularities and infertility), rheumatologists (joint problems), or pulmonologist (sleep apnea) [ 21 , 22 ]. Many studies have provided diagnostic algorithms to help in the identification and confirmation of acromegaly [ 21 , 23 , 24 ], and one recent study, which has yet to be validated, has provided a scoring system to aid in the early recognition of signs and symptoms [ 25 ]. This scoring system, termed ‘ACROSCORE’, is intended to be used by general practitioners and nonendocrinology specialists to help in diagnosis by scoring symptoms, and depending on the final score, the patient can then be refereed for a more detailed investigation by endocrinologist.…”

Section: Introductionmentioning

confidence: 99%

“…This scoring system, termed ‘ACROSCORE’, is intended to be used by general practitioners and nonendocrinology specialists to help in diagnosis by scoring symptoms, and depending on the final score, the patient can then be refereed for a more detailed investigation by endocrinologist. [ 25 ].…”

Section: Introductionmentioning

confidence: 99%

Challenges in the diagnosis and management of acromegaly: a focus on comorbidities

et al. 2016

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IntroductionAcromegaly is a rare, insidious disease resulting from the overproduction of growth hormone (GH) and insulin-like growth factor 1 (IGF-1), and is associated with a range of comorbidities. The extent of associated complications and mortality risk is related to length of exposure to the excess GH and IGF-1, thus early diagnosis and treatment is imperative. Unfortunately, acromegaly is often diagnosed late, when patients already have a wide range of comorbidities. The presence of comorbid conditions contributes significantly to patient morbidity/mortality and impaired quality of life.MethodsWe conducted a retrospective literature review for information relating to the diagnosis of acromegaly, and its associated comorbidities using PubMed. The main aim of this review is to highlight the issues of comorbidities in acromegaly, and to reinforce the importance of early diagnosis and treatment.Findings and conclusionsSuccessful management of acromegaly goes beyond treating the disease itself, since many patients are diagnosed late in disease evolution, they present with a range of comorbid conditions, such as cardiovascular disease, diabetes, hypertension, and sleep apnea. It is important that patients are screened carefully at diagnosis (and thereafter), for common associated complications, and that biochemical control does not become the only treatment goal. Mortality and morbidities in acromegaly can be reduced successfully if patients are treated using a multimodal approach with comprehensive comorbidity management.

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ACROSCORE: a new and simple tool for the diagnosis of acromegaly, a rare and underdiagnosed disease

Abstract: Once validated in independent studies, ACROSCORE may represent a new tool for the clinical screening of acromegaly that can be used by general practitioners and nonendocrinology specialists.

Cited by 31 publications

References 27 publications

Signs and symptoms of acromegaly at diagnosis: the physician’s and the patient’s perspectives in the ACRO-POLIS study

Signs and symptoms of acromegaly at diagnosis: the physician’s and the patient’s perspectives in the ACRO-POLIS study

Acromegaly: a challenging condition to diagnose

Challenges in the diagnosis and management of acromegaly: a focus on comorbidities

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