Racial Disparities in Acromegaly and Cushing\u27s Disease: A Referral Center Study in 241 Patients

Context: Acromegaly (ACM) and Cushing\u27s disease (CD) are caused by functioning pituitary adenomas secreting growth hormone and ACTH respectively. Objective: To determine the impact of race on presentation and postoperative outcomes in adults with ACM and CD, which has not yet been evaluated. Methods: This is a retrospective study of consecutive patients operated at a large-volume pituitary center. We evaluated (1) racial distribution of patients residing in the metropolitan area (Metro, N=124) vs 2010 US census data, and(2) presentation and postoperative outcomes in Black vs White for patients from the entire catchment area (N=241). Results: For Metro area (32.4% Black population), Black patients represented 16.75% ACM (P=.006) and 29.2% CD (P=.56). Among the total 112 patients with ACM, presentations with headaches or incidentaloma were more common in Black patients (76.9% vs 31% White, P=.01). Black patients had a higher prevalence of diabetes (54% vs 16% White, P=.005), significantly lower interferon insulin-like growth factor (IGF)-1 deviation from normal (P=.03) and borderline lower median growth hormone levels (P=.09). Mean tumor diameter and proportion of tumors with cavernous sinus invasion were similar. Three-month biochemical remission (46% Black, 55% White, P=.76) and long-term IGF-1 control by multimodality therapy (92.3% Black, 80.5% White, P=.45) were similar. Among the total 129 patients with CD, Black patients had more hypopituitarism (69% vs 45% White, P=.04) and macroadenomas (33% vs 15% White, P=.05). At 3 months, remission rate was borderline higher in White (92% vs 78% Black, P=0.08), which was attributed to macroadenomas by logistic regression. Conclusion: We identified disparities regarding racial distribution, and clinical and biochemical characteristics in ACM, suggesting late or missed diagnosis in Black patients. Large nationwide studies are necessary to confirm our findings

Gender differences and temporal trends over two decades in acromegaly: a single center study in 112 patients

Purpose: To evaluate the impact of gender and year at surgery on clinical presentation and postoperative outcomes in acromegaly. Methods: Retrospective review of patients operated between 1994 and 2016 to compare presentation and outcomes in groups defined by gender and year of surgery. Kaplan–Meier survival analyses with a composite endpoint (recurrence, reoperation, and radiation) were used for gender comparison and Youden indices for biochemical remission rates changes during study period. Results: Primary indications for evaluation were phenotype, neurological symptoms, incidentaloma, hypogonadism, and galactorrhea. At surgery, men (N = 54) were younger (43.6 ± 12.7 years) than women (N = 58, 48.7 ± 12.3, P = 0.04). Male:female ratios before and after age 50 were 1.4 and 0.6 respectively. Men had higher mean IGF-1 levels (874 ± 328 vs 716 ± 296, P \u3c 0.01) and smaller tumors (1.8 ± 1.3 cm vs 2.3 ± 1.5, P = 0.04). Postoperative remission rates were comparable (51% men, 56% women) and inversely associated with cavernous sinus invasion and GH levels. Women had longer mean follow-up (5.2 ± 3.4 years vs 3.6 ± 3.6 men, P = 0.02) and longer endpoint-free survival (P \u3c 0.01). At last follow-up, 89.6% women and 70% men had normal IGF-1 levels (P = 0.03). Postoperative remission rates were higher in patients operated after February 15, 2011 (67.35 vs 43.5% previously, P = 0.01). In late vs early surgery group, physical changes as main indication for screening decreased (54 vs 30%, P \u3c 0.01), while incidentaloma and hypogonadism increased. Median GH levels were lower in late vs early surgery group (P = 0.03). Conclusion: We demonstrate gender-specific characteristics and an evolving spectrum of clinical presentation with implications for earlier diagnosis and personalized management of acromegaly