Demographic Factors and the Presence of Comorbidities do not Promote Early Detection of Cushing's Disease and Acromegaly

Abstract

Objective: The aim of the study was to analyze the time-to-diagnosis interval in patients with Cushing's disease (CD) and acromegaly (AC), to assess factors that promote early disease detection and to investigate the medical fields diagnosing the pathologies.

Methods: 33 CD and 52 AC patients operated over 10 years received a self-designed disease-related questionnaire. Data about symptoms and their duration prior to diagnosis, education level, age, gender and place of residence (i. e. rural vs. urban, size of the city) were collected.

Results: The mean time-to-diagnosis interval was 6.0 years in CD and 5.8 years in AC patients. The vast majority of 67% of all investigated patients was diagnosed after they changed their primary health care provider or during a hospital stay owing to comorbidities caused by their underlying disease. Only 33% of all cases were diagnosed by their primary physician. In both groups neither gender, age, place of residence, education level, typical comorbidities (e. g. hypertension or diabetes) nor distinctive symptoms and bodily changes of the underlying disease (e. g. prognathism, acral enlargement, weight gain, buffalo hump) were significant factors promoting early detection.

Conclusions: Apparently, patient-related factors do not affect the time-to-diagnosis interval, but rather the change of the primary health care provider. Knowledge of the disease among physicians is prerequisite to early detection. Due to the deleterious sequelae of delayed diagnosis, information programmes in the medical community are of paramount importance. Institution of screening programmes should be evaluated.

Key words

Cushing's disease - acromegaly - comorbidities - time-to-diagnosis interval - social factors

References

• 1 Alexander L, Appleton D, Hall R. et al . Epidemiology of acromegaly in the Newcastle region.  Clin Endocrinol. 1980;  12 71-79
• 2 Arnaldi G, Angeli A, Atkinson AB. et al . Diagnosis and complications of Cushing's syndrome: a consensus statement.  J Clin Endocrinol Metab. 2003;  88 5593-5602
• 3 Bengtsson BA, Eden S, Ernest I. et al . Epidemiology and long term survival in acromegaly. A study of 166 cases diagnosed between 1955 and 1984.  Acta Med Scand. 1988;  223 327-335
• 4 Bogazzi F, Battolla L, Spinelli C. et al . Risk factors for development of coronary heart disease in patients with acromegaly: a five-year prospective study.  J Clin Endocrinol Metab. 2007;  92 4271-4277
• 5 Boscaro M, Barzon L, Fallo F. et al . Cushing's syndrome.  Lancet. 2001;  357 783-791
• 6 Cavagnini F, Pecori Girald F. Epidemiology and follow-up of Cushing's disease.  Ann Endocrinol. 2001;  62 168-172
• 7 Coculescu M, Niculescu D, Lichiardopol R. et al . Insulin resistance and insulin secretion in non-diabetic acromegalic patients.  Exp Clin Endocrinol Diabetes. 2007;  115 308-316
• 8 Daly AF, Petrossians P, Beckers A. An overview of the epidemiology and genetics of acromegaly.  J Endocrinol Invest. 2005;  28 (Suppl) 67-69
• 9 De P, Evans LM, Scanlon MF. et al . Osler's phenomenon: misdiagnosing Cushing's syndrome.  Postgrad Med J. 2003;  79 594-596
• 10 Etxabe J, Vazquez JA. Morbidity and mortality in Cushing's disease: an epidemiological approach.  Clin Endocrinol. 1993;  40 479-484
• 11 Etxabe J, Gaztambide S, Latorre P. et al . Acromegaly: an epidemiological study.  J Endocrinol Invest. 1993;  16 181-187
• 12 Findling JW, Raff H. Cushing's syndrome: important issues in diagnosis and management.  J Clin Endocrinol Metab. 2006;  91 3746-3753
• 13 Holdaway IM, Rajasoorya C. Epidemiology of acromegaly.  Pituitary. 1999;  2 29-41
• 14 Holdaway IM, Rajasoorya RC, Gamble GD. Factors influencing mortality in acromegaly.  J Clin Endocrinol Metab. 2004;  89 667-674
• 15 Kauppinen-Mäkelin R, Sane T, Reunanen A. et al . A nationwide survey of mortality in acromegaly.  J Clin Endocrinol Metab. 2005;  90 4081-4086
• 16 Melmed S, Colao A, Barkan A. et al . Guidelines for acromegaly management: an update.  J Clin Endocrinol Metab. 2009;  94 1509-1517
• 17 Molitch M. Clinical manifestations of acromegaly.  Endocrinol Metab Clin North Am. 1992;  21 597-614
• 18 Monson JP. The epidemiology of endocrine tumours.  Endocr Relat Cancer. 2000;  7 29-36
• 19 Nabarro JD. Acromegaly.  Clin Endocrinol. 1987;  26 481-512
• 20 Nachtigall L, Delgado A, Swearingen B. et al . Extensive clinical experience: Changing patterns in diagnosis and therapy of acromegaly over two decades.  J Clin Endocrinol Metab. 2008;  93 2035-2041
• 21 Pereira AM, van Thiel SW, Lindner JR. et al . Increased prevalence or regurgitant valvular heart disease in acromegaly.  J Clin Endocrinol Metab. 2004;  89 71-75
• 22 Plotz CM, Knowlton AI, Ragan C. The natural history of Cushing's Syndrome.  Am J Med. 1952;  13 597-614
• 23 Reimondo G, Pia A, Allasino B. et al . Screening for Cushing's syndrome in adult patients with newly diagnosed diabetes mellitus.  Clin Endocrinol. 2007;  67 225-229
• 24 Ross EJ, Linch DC. Cushing's syndrome-killing disease: discriminatory value of signs and symptoms aiding early diagnosis.  Lancet. 1982;  2 646-649
• 25 Swearingen B, Barker FG, Katznelson L. et al . Long-term mortality after transsphenoidal surgery and adjunctive therapy for acromegaly.  J Clin Endocrinol Metab. 1998;  10 3419-3426

Correspondence