Extensive clinical experience: Changing patterns in diagnosis and therapy of acromegaly over two decades
Extensive clinical experience: Changing patterns in diagnosis and therapy of acromegaly over two decades
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DOI：
10.1210/jc.2007-2149
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发表时间：
2008-06-01
影响因子：
5.8
通讯作者：
Klibanski, Anne
中科院分区：
文献类型：
--
作者：
Nachtigall, Lisa;Delgado, Adriano;Klibanski, Anne
背景：肢端肥大症发病率和死亡率的增加使得早期诊断和治疗至关重要。然而，首次诊断肢端肥大症的医疗专业人员的类型、引起医疗关注的主要主诉，或在新医学疗法设置中使用的管理范式是否随着时间的推移而发生了变化，尚未得到很好的探讨。目的：我们的目的是确定最初怀疑肢端肥大症的医疗专业人员和促使诊断的主诉，以及这些是否发生了变化。其他目标是评估从症状发作到肢端肥大症诊断的时间间隔，并比较连续几十年的治疗趋势。设计：这是一项病例记录回顾性研究。环境：研究在三级保健中心的神经内分泌临床中心进行。研究对象：1985-2005年共纳入100例肢端肥大症患者（男性45例，女性55例）。结果：肢端改变（24%）和头痛（20%）是最常见的提示诊断的症状。18%的人在诊断时没有肢端肥大症的症状。初级保健医生最常发起评估（44%）。合并症在老年患者中更为普遍（P = 0.001）。与以前的报告相比，症状发作和诊断之间的时间间隔缩短了。1994年之后的十年中，放疗的使用频率低于之前（16% vs. 33%; P < 0.05）。结论：初级保健医生在肢端肥大症的诊断中起主要作用。脑磁共振成像使用的增加可能有助于许多偶然发现的病例和缩短诊断间隔时间。大概是由于新的医学疗法的出现，放射疗法的使用已经减少了。
Background: The increased morbidity and mortality of acromegaly makes early diagnosis and therapy critical. However, whether the type of medical professional who first diagnoses acromegaly, the major complaint prompting medical attention, or the management paradigms used in the setting of novel medical therapies have changed over time has not been well explored.Objectives: Our objective was to identify the medical professional who first suspected acromegaly and the complaint prompting the diagnosis, and if these have changed. Additional goals were to assess the interval from symptom onset to diagnosis of acromegaly and to compare treatment trends over consecutive decades.Design: This was a case-record retrospective study.Setting: The study was performed in a neuroendocrine clinical center at a tertiary care center.Subjects: A total of 100 patients (45 men and 55 women) with acromegaly referred from 1985-2005 was included in the study.Results: Acral changes (24%) and headaches (20%) were most prevalent presenting symptoms prompting diagnosis. Eighteen percent reported no symptoms of acromegaly at diagnosis. The primary care physician most often initiated the evaluation (44%). Comorbidities were more prevalent in older patients (P = 0.001). The interval between symptom onset and diagnosis decreased, compared with previous reports. Radiation therapy was used less frequently in the decade after 1994 than in the prior (16 vs. 33%; P < 0.05).Conclusions: The primary care doctor plays the major role in diagnosis of acromegaly. The increased use of brain magnetic resonance imaging may contribute to the many incidentally discovered cases and to the shortened time interval to diagnosis. Presumably due to the availability of new medical therapies, the use of radiation therapy has decreased.