Acromegaly: Incidence, patient characteristics and treatment patterns in a 10-year nationwide retrospective hospital cohort study

Grégoire Fauchier; Emeline Laurent; Luigi Maione; Anne-Isabelle Lecuyer; Julien Herbert; Peggy Pierre-Renoult; Lucie Cloix; Philippe Chanson; Pierre-Henri Ducluzeau; Leslie Grammatico-Guillon

doi:10.1016/j.ando.2024.09.002

Acromegaly: Incidence, patient characteristics and treatment patterns in a 10-year nationwide retrospective hospital cohort study

Ann Endocrinol (Paris). 2024 Sep 20:S0003-4266(24)00732-7. doi: 10.1016/j.ando.2024.09.002. Online ahead of print.

Affiliations

¹ Department of Endocrinology, Diabetes and Nutrition, Teaching Hospital of Tours, Tours, France; Service of Public Health, Epidemiology, Clinical Data, University Hospital of Tours, Tours, France. Electronic address: [email protected].
² Service of Public Health, Epidemiology, Clinical Data, University Hospital of Tours, Tours, France; Research unit EA7505 (Éducation Éthique et Santé), University of Tours, Tours, France. Electronic address: [email protected].
³ Inserm, Endocrine Physiology and Physiopathology, Department of Endocrinology and Reproductive Diseases and Reference Centre for Rare Hypophysial Diseases, Bicêtre Hospital, University Paris-Saclay, Assistance publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France. Electronic address: [email protected].
⁴ Service of Public Health, Epidemiology, Clinical Data, University Hospital of Tours, Tours, France; Research unit EA7505 (Éducation Éthique et Santé), University of Tours, Tours, France. Electronic address: [email protected].
⁵ Service of Public Health, Epidemiology, Clinical Data, University Hospital of Tours, Tours, France. Electronic address: [email protected].
⁶ Department of Endocrinology, Diabetes and Nutrition, Teaching Hospital of Tours, Tours, France. Electronic address: [email protected].
⁷ Department of Endocrinology, Diabetes and Nutrition, Teaching Hospital of Orléans, Orléans, France. Electronic address: [email protected].
⁸ Inserm, Endocrine Physiology and Physiopathology, Department of Endocrinology and Reproductive Diseases and Reference Centre for Rare Hypophysial Diseases, Bicêtre Hospital, University Paris-Saclay, Assistance publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France. Electronic address: [email protected].
⁹ Department of Endocrinology, Diabetes and Nutrition, Teaching Hospital of Tours, Tours, France; Faculty of Medicine, University of Tours, Tours, France. Electronic address: [email protected].
¹⁰ Service of Public Health, Epidemiology, Clinical Data, University Hospital of Tours, Tours, France; Faculty of Medicine, University of Tours, Tours, France. Electronic address: [email protected].

PMID: 39307237
DOI: 10.1016/j.ando.2024.09.002

Abstract

Introduction: Acromegaly is a multisystemic disease associated with numerous comorbidities, notably cardiovascular disease and cancer. The objective of our study was to estimate the contemporary prevalence and incidence of acromegaly and its complications in a nationwide French retrospective cohort.

Methods: First, the positive predictive value of the ICD-10 acromegaly code E22.0 was checked by individually reviewing 132 medical records from one teaching hospital. Second, to estimate the prevalence of acromegaly, data of patients hospitalized between 2012 and 2021 were extracted from the PMSI French hospital database, using the dedicated ICD-10 code. Third, in a 2015-2020 subset cohort, we estimated the incidence of acromegaly, prevalence of complications and risk ratios of associated comorbidities or complications in subgroups of interest.

Results: A total of 7943 adult patients were identified, with a positive predictive value of 87%, resulting in a prevalence of 10.4/100,000 in France. Annual incidence was 0.76/100,000. The most frequent complications were hypertension (43%), sleep apnea (34.3%) and diabetes (31.3%), mostly with onset before diagnosis. Patients with diabetes were at higher risk for most comorbidities: myocardial infarction (odds ratio (OR) 3.14 [1.92-5.13]), ischemic stroke (1.64 [1.18-2.28]) and cancer of any type (1.53 [1.27-1.84]). These risks were partially attenuated after adjustment for other cardiovascular risk factors, becoming respectively 1.52 [0.89-2.59], 0.92 [0.64-1.33] and 1.09 [0.88-1.34]. Treatment involved pituitary surgery in 43% and radiotherapy in 4.6% of patients.

Conclusion: This study was the first, in a large population, to estimate the contemporary incidence and prevalence of acromegaly in non-selected patients at nationwide level in France. We found higher prevalences of complications than previously reported in tertiary specialized expert centers, probably reflecting suboptimal management in non-selected hospitals, whether specialized or not.

Keywords: Acromegaly; Anterior pituitary; Epidemiology; Nationwide analysis.