Prevalence of acromegaly in patients with symptoms of sleep apnea

• Published in: PloS one 2017-09, Vol.12 (9), p.e0183539-e0183539
• Main Authors: Sesmilo, Gemma, Resmini, Eugenia, Sambo, Marcel, Blanco, Concepción, Calvo, Fernando, Pazos, Fernando, Fernández-Catalina, Pablo, Martínez de Icaya, Purificación, Páramo, Concepción, Fajardo, Carmen, Marazuela, Mónica, Álvarez-Escolá, Cristina, Díez, Juan Jose, Perea, Verónica
• Format: Article
• Language: English
• Subjects: Acromegaly; Acromegaly - epidemiology; Acromegaly - etiology; Acromegaly - metabolism; Adult; Aged; Apnea; Biology and Life Sciences; Biomarkers; Carpal tunnel syndrome; Clinical medicine; Data processing; Diabetes; Diagnosis; Endocrinology; Enlargement; Epidemiology; Expansion; Female; Humans; Hypertension; Insulin; Insulin-like growth factor I; Insulin-Like Growth Factor I - metabolism; Insulin-like growth factors; Male; Medical screening; Medicine and Health Sciences; Middle Aged; NMR; Nuclear magnetic resonance; Overuse injuries; Paresthesia; Patients; Physiological aspects; Population; Prevalence; Prevalence studies (Epidemiology); Primary care; Rare diseases; Research and Analysis Methods; Sleep; Sleep apnea; Sleep Apnea Syndromes - complications; Sleep Apnea Syndromes - diagnosis; Sleep disorders; Spain - epidemiology; Statistics; Teeth; Tongue; Widening
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0183539

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.