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Acromegaly (ACROM) in Emilia Romagna (ER): results from the ACROMER, a multicentric survey over 45 years

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ACROMEGALY ACROM IN EMILIA ROMAGNA ER RESULTS FROM THE

ACROMER A MULTICENTRIC SURVEY OVER

YEARS

V R chi a U Pag M C Za e i M R A b i A Ba e ie i F B di R B ad a M B da e i S Ca a d G Ce e i i R De Gi a i A F a da i F G a a di V L eia E Mae i M Ma i a D Ma a e a E Mag a i M L M a i V M e i M T Na i M Ni i D Pa c i F Riga i D Ribichi i C Sa i i A S ia i A Ta ag ia S Ve a i M Zi i M Fa i i F i i

E d c i gia U i e i à di M de a e Reggi E i ia M de a E d c i gia U i e i à di B g a B g a E d c i gia U i e i à di Fe a a Fe a a E d c i gia Ce e a E d c i gia Ra e a E d c i gia e Ma a ie de Me ab i U i e i à di Pa a Pa a Medici a I e a O c E d c i gica U i e i à di Pa a Pa a Medici a I e a Ricci e E d c i gia AUSL IRCCS Reggi E i ia Pi i a U i IRCCS Be a ia B g a E d c i gia G a a a Reggi E i ia Ne chi gia Ce e a E d c i gia F E d c i gia Piace a

BACKGROUND Acromegaly is a rare disease, the incidence and prevalence of which are underestimated due to many factors such as late or missed diagnosis and paucity of registries.

AIM To collect in a large database (AcromER) all available data on acromegalic patients of Emilia

Romagna (ER) over a period of years.

METHODS Retrospective, observational, multicenter study involving adult ( years) acromegalic

patients followed in Endocrine Clinics of ER in the period - . The study was approved by the

Ethical Committee of the clinical centers. Main information on diagnosis, treatment and

comorbidities of each patient were collected in a standardized CRF. The same patient who was followed in two or more centers was considered once.

RESULTS A total of patients [ F ( , ), median age at diagnosis of years ( - ), median

follow-up: , years were included. Estimated incidence and prevalence were . per year and .

cases per . . Somatic changes ( , ), headache ( , ), snoring ( , ), menstrual

abnormalities in females ( ), hyperhidrosis ( , ), and visual impairment ( , ) were the most

frequent symptoms at diagnosis. Micro and macroadenomas were , and , , respectively. The

age at diagnosis was significantly lower in patients with macro than in those with microadenomas

(p , ). Surgery was the first line therapy in patients ( , ), medical therapy in ( , ).

Surgery resulted in persistent disease remission in of cases, in transient remission with subsequent

relapse in , and in no cure in . Remission occurred more frequently in micro than

macroadenomas (p , ) and in trans-sphenoidal endoscopic approach (p , ). Somatostatin

analogues (SSA) were used after surgery in of cases, dopamine agonists (DA) in , and DA SSA in

. SSAs, DA, and DA SSAs were used as first line medical therapy in , , and of cases. At

last follow-up of patients were cured, had controlled disease, and uncontrolled disease.

With exception of cancer, all the other comorbidities were more frequent in patients treated with first

line medical therapy compared to surgery or surgery medical therapy (p , ). The use of Pegvisomant

was more frequent in tertiary than in smaller endocrinological centers (p , ).

CONCLUSIONS This is the first Italian epidemiological analysis coming from an endocrinological network covering the whole area of an Italian region. In the single regional setting of ER the management of acromegaly and the treatments outcomes resulted to be aligned with other European reports. Furthermore, these data speak in favor of homogeneity of acromegaly management in the Endocrine Clinics of ER.

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