Danilowicz K.,University of Buenos Aires |
Day P.F.,Endocrine and Nuclear Medicine Unit |
Manavela M.P.,University of Buenos Aires |
Herrera C.J.,Hospital Central |
And 4 more authors.
Introduction: Acromegaly is a rare disease with a large burden due its associated comorbidities and the life-long management required. Since the occurrence and severity of associated complications are related to length of exposure to the excess growth hormone seen in acromegaly, early diagnosis is imperative. The delay in diagnosis, however, can be long, and may be the result of a lack of disease awareness and screening programs. Since acromegaly is an uncommon disease, finding ways to increase recognition and diagnosis that would permit early detection in a logical and cost-effective manner could be a challenge. Methods: We conducted a retrospective literature review for information relating to the screening and diagnosis of acromegaly using PubMed. The aim was to assess whether an acromegaly-screening program in Latin America (and elsewhere) would be both of use and be feasible. Findings and conclusions: An earlier diagnosis allows earlier initiation of treatment, such as surgery and/or drugs, which leads to more successful disease management (biochemical control) and better outcomes. Since the delay in diagnosis can be long, we believe that clear opportunities exist for earlier (and increased) detection of acromegaly. This can be achieved by increasing disease awareness for earlier recognition of symptoms and by using targeted screening (rather than mass screening) programs. © 2016 Springer Science+Business Media New York Source
Fainstein Day P.,Endocrine and Nuclear Medicine Unit |
Glerean M.,Endocrine and Nuclear Medicine Unit |
Lovazzano S.,Endocrine and Nuclear Medicine Unit |
Pietrani M.,Radiology Unit |
And 4 more authors.
Frontiers of Hormone Research
Prolactinomas in men are usually macroprolactinomas and other investigators have attributed bigger size of tumors in men to delay in diagnosis. A retrospective study of 71 macroadenomas (42 men) was carried out. Parameters studied were age, signs and symptoms at presentation, time of onset of symptoms, basal prolactin, estradiol, and total testosterone levels, tumor size and Ki 67 expression in tumor tissue. Male patients were older. Visual defects were significantly more prevalent in men. Hardy 4 stage tumors were found only in men. We found no significant correlation between tumor size and the patients age nor between tumor size and the onset of symptoms. Whereas basal E2 levels (21.2 ± 12.9 vs. 33.3 ± 43.3 pg/ml, p = n.s.) were very similar in male and female patients, testosterone levels were significantly higher in men (0.6 ± 0.5 vs. 1.8 ± 1.2 ng/ml, p = 0.02). The rate of cell proliferation represented by Ki 67 was significantly higher in tumors in men (3.5 ± 1.2 vs. 1.5 ± 0.5%, p = 0.0001). This is the first study focused in macroprolactinomas that shows that they are clinically and biologically more aggressive in men. Hypogonadism in men could appear later in the progression of prolactinomas and this might explain why men were older at the time of diagnosis. Furthermore, testosterone could be a source for E2 in situ aromatization giving male tumors an advantage in cell proliferation. Copyright © 2010 S. Karger AG, Basel. Source