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Al Dahmani K, Afandi B, Elhouni A, Dinwal D, Philip J, Bashier A, Beshyah SA, Nagelkerke N, Alkaabi JM. Clinical Presentation, Treatment, and Outcome of Acromegaly in the United Arab Emirates. Oman Med J 2020; 35:e172. [PMID: 32995046 PMCID: PMC7503193 DOI: 10.5001/omj.2020.114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 03/04/2020] [Indexed: 01/01/2023] Open
Abstract
Objectives We sought to ascertain the clinical characteristics and control rate of acromegaly in the UAE. Methods We conducted a multicenter retrospective analysis of all patients presenting with acromegaly to six endocrine centers in the UAE between November 2010 and December 2018. Demographic, clinical, biochemical, and radiologic data were collected. Patients were considered controlled if normal insulin-like growth factor-1 (IGF-1) level and growth hormone < 1 mcg/L were achieved at their last visit. Results A total of 75 patients were included in the study (60.0% males, 33.3% native UAE nationals). The mean age at diagnosis was 37.2 (range: 12-69) years. Common clinical features at diagnosis were headache (82.4%), coarse facial features (82.4%), acral enlargement (79.7%), and sweating (31.3%). Diabetes mellitus/prediabetes and hypertension were present in 45.2% and 35.5% of patients, respectively. About 82.2% had pituitary macroadenoma on pituitary magnetic resonance imaging. At presentation, 27.0% and 3.2% of the patients had secondary hypogonadism and diabetes insipidus, respectively. Overall, 76.7% of the patients underwent surgery, 20.8% received radiotherapy, and 50.7% received medical therapy. At their last clinic visit, only 43.7% of all patients achieved disease control. Conclusions Our study shows a high prevalence of pituitary macroadenoma in our acromegalic population, suggesting a delayed diagnosis. Also, a significant proportion of patients remained uncontrolled. Efforts to increase physician's awareness of acromegaly and to improve disease control are underway.
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Affiliation(s)
- Khaled Al Dahmani
- Endocrine and Diabetes Center, Tawam Hospital, Al Ain, UAE.,Department of Medicine, College of Medicine and Health Science, UAE University, Al Ain, UAE
| | - Bachar Afandi
- Endocrine and Diabetes Center, Tawam Hospital, Al Ain, UAE.,Department of Medicine, College of Medicine and Health Science, UAE University, Al Ain, UAE
| | - Ali Elhouni
- Endocrine and Diabetes Center, Tawam Hospital, Al Ain, UAE.,Department of Medicine, College of Medicine and Health Science, UAE University, Al Ain, UAE
| | - Denish Dinwal
- Division of Endocrinology, New Medical Center, Abu Dhabi, UAE
| | - Jim Philip
- Division of Endocrinology, New Medical Center, Al Ain, UAE
| | - Alaaeldin Bashier
- Department of Endocrinology, Dubai Hospital, Dubai Health Authority, Dubai, UAE
| | - Salem A Beshyah
- Division of Endocrinology, Mediclinic, Abu Dhabi, UAE.,Department of Medicine, Dubai Medical College, Dubai, UAE
| | | | - Juma M Alkaabi
- Department of Medicine, College of Medicine and Health Science, UAE University, Al Ain, UAE.,Division of Endocrinology, Al Ain Hospital, Al Ain, UAE
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Giustina A, Bronstein MD, Chanson P, Petersenn S, Casanueva FF, Sert C, Houchard A, Melmed S. Staging and managing patients with acromegaly in clinical practice: baseline data from the SAGIT® validation study. Pituitary 2019; 22:476-487. [PMID: 31338660 PMCID: PMC6728296 DOI: 10.1007/s11102-019-00977-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The SAGIT® instrument, designed to assist clinicians to stage acromegaly, assess treatment response and adapt patient management, was well received by endocrinologists in a pilot study. We report an interim analysis of baseline data from the validation phase. METHODS The SAGIT® validation study (ClinicalTrials.gov NCT02539927) is an international, non-interventional study. Data collection included: demographic/disease characteristics; medical/surgical histories; concomitant acromegaly treatments; investigators' subjective evaluation of disease-control status (clinical global evaluation of disease control [CGE-DC]; controlled/not controlled/yet to be clarified) and clinical disease activity (active/not active); growth hormone (GH) and insulin-like growth factor-1 (IGF-1) levels; investigators' therapeutic decision. RESULTS Of 228 patients enrolled, investigators considered disease to be controlled in 110 (48.2%), not controlled in 105 (46.1%), and yet to be clarified in 13 (5.7%) according to CGE-DC. Thirty-three patients were treatment-naïve (not controlled, n = 31; yet to be clarified, n = 2). Investigators considered 48.2% patients in the controlled and 95.2% in the not-controlled groups to have clinically active disease. In the controlled group, 29.7% of patients did not exhibit hormonal control (GH ≤ 2.5 µg/L; normalized IGF-1) and 47.3% did not have rigorous hormonal control (GH < 1.0 µg/L; normalized IGF-1) by contemporary consensus. Current acromegaly treatment was continued with no change for 91.8% of patients in the controlled and 40.0% in the not-controlled groups. CONCLUSIONS These data highlight discrepancies between investigator-evaluated disease-control status, disease activity, hormonal control, and treatment decisions in acromegaly. Once validated, the SAGIT® instrument may assist clinicians in making active management decisions for patients with acromegaly.
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Affiliation(s)
- Andrea Giustina
- San Raffaele University Hospital Milan, 20132, Milan, Italy.
| | | | - Philippe Chanson
- Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Centre de Référence des Maladies Rares de l'Hypophyse (HYPO), Service d'Endocrinologie et des Maladies de la Reproduction and Univ Paris-Sud, University Paris-Saclay, Paris, Le Kremlin Bicêtre, France
| | | | - Felipe F Casanueva
- Instituto Salud Carlos III, Santiago de Compostela University - CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Santiago de Compostela, Spain
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