PDF(Pubmed)
Abstract：
OBJECTIVE: Diagnostic delay is high in acromegaly and leads to increased morbidity and mortality. The aim of this study is to systematically assess the most prevalent clinical signs, symptoms and comorbidities of acromegaly at time of diagnosis.
METHODS: A literature search (in PubMed, Embase and Web of Science) was performed on November 18, 2021, in collaboration with a medical information specialist.
METHODS: Prevalence data on (presenting) clinical signs, symptoms and comorbidities at time of diagnosis were extracted and synthesized as weighted mean prevalence. The risk of bias was assessed for each included study using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data.
RESULTS: Risk of bias and heterogeneity was high in the 124 included articles. Clinical signs and symptoms with the highest weighted mean prevalence were: acral enlargement (90%), facial features (65%), oral changes (62%), headache (59%), fatigue/tiredness (53%; including daytime sleepiness: 48%), hyperhidrosis (47%), snoring (46%), skin changes (including oily skin: 37% and thicker skin: 35%), weight gain (36%) and arthralgia (34%). Concerning comorbidities, acromegaly patients more frequently had hypertension, left ventricle hypertrophy, dia/systolic dysfunction, cardiac arrhythmias, (pre)diabetes, dyslipidemia and intestinal polyps- and malignancy than age- and sex matched controls. Noteworthy, cardiovascular comorbidity was lower in more recent studies. Features that most often led to diagnosis of acromegaly were typical physical changes (acral enlargement, facial changes and prognatism), local tumor effects (headache and visual defect), diabetes, thyroid cancer and menstrual disorders.
CONCLUSIONS: Acromegaly manifests itself with typical physical changes but also leads to a wide variety of common comorbidities, emphasizing that recognition of a combination of these features is key to establishing the diagnosis.
METHODS: A literature search (in PubMed, Embase and Web of Science) was performed on November 18, 2021, in collaboration with a medical information specialist.
METHODS: Prevalence data on (presenting) clinical signs, symptoms and comorbidities at time of diagnosis were extracted and synthesized as weighted mean prevalence. The risk of bias was assessed for each included study using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data.
RESULTS: Risk of bias and heterogeneity was high in the 124 included articles. Clinical signs and symptoms with the highest weighted mean prevalence were: acral enlargement (90%), facial features (65%), oral changes (62%), headache (59%), fatigue/tiredness (53%; including daytime sleepiness: 48%), hyperhidrosis (47%), snoring (46%), skin changes (including oily skin: 37% and thicker skin: 35%), weight gain (36%) and arthralgia (34%). Concerning comorbidities, acromegaly patients more frequently had hypertension, left ventricle hypertrophy, dia/systolic dysfunction, cardiac arrhythmias, (pre)diabetes, dyslipidemia and intestinal polyps- and malignancy than age- and sex matched controls. Noteworthy, cardiovascular comorbidity was lower in more recent studies. Features that most often led to diagnosis of acromegaly were typical physical changes (acral enlargement, facial changes and prognatism), local tumor effects (headache and visual defect), diabetes, thyroid cancer and menstrual disorders.
CONCLUSIONS: Acromegaly manifests itself with typical physical changes but also leads to a wide variety of common comorbidities, emphasizing that recognition of a combination of these features is key to establishing the diagnosis.
摘要：
目的：肢端肥大症的诊断延迟高，导致发病率和死亡率增加。这项研究的目的是系统地评估最普遍的临床症状，诊断时肢端肥大症的症状和合并症。
方法：文献检索(在PubMed，Embase和WebofScience）于2021年11月18日与医学信息专家合作进行。
方法：（呈现）临床体征的患病率数据，提取诊断时的症状和合并症,并将其合成为加权平均患病率.使用JoannaBriggs研究所报告患病率数据的关键评估清单评估每个纳入研究的偏倚风险。
结果：在纳入的124篇文章中，偏倚和异质性的风险很高。加权平均患病率最高的临床体征和症状是：肢端增大（90％），面部特征（65%），口腔变化（62%），头痛（59%）疲劳/疲倦（53％；包括白天嗜睡：48％），多汗症（47%），打鼾（46%），皮肤变化（包括油性皮肤：37％和较厚的皮肤：35％），体重增加（36％）和关节痛（34％）。关于合并症，肢端肥大症患者更频繁地患有高血压，左心室肥厚,舒张/收缩功能障碍，心律失常,（前）糖尿病，血脂异常和肠息肉-和恶性肿瘤比年龄和性别匹配的对照组。值得注意的是,在最近的研究中,心血管合并症较低.最常导致肢端肥大症诊断的特征是典型的物理变化（肢端增大，面部变化和前兆)，局部肿瘤影响（头痛和视觉缺陷），糖尿病,甲状腺癌和月经失调。
结论：肢端肥大症表现为典型的物理变化，但也导致各种常见的合并症，强调识别这些特征的组合是建立诊断的关键。
方法：文献检索(在PubMed，Embase和WebofScience）于2021年11月18日与医学信息专家合作进行。
方法：（呈现）临床体征的患病率数据，提取诊断时的症状和合并症,并将其合成为加权平均患病率.使用JoannaBriggs研究所报告患病率数据的关键评估清单评估每个纳入研究的偏倚风险。
结果：在纳入的124篇文章中，偏倚和异质性的风险很高。加权平均患病率最高的临床体征和症状是：肢端增大（90％），面部特征（65%），口腔变化（62%），头痛（59%）疲劳/疲倦（53％；包括白天嗜睡：48％），多汗症（47%），打鼾（46%），皮肤变化（包括油性皮肤：37％和较厚的皮肤：35％），体重增加（36％）和关节痛（34％）。关于合并症，肢端肥大症患者更频繁地患有高血压，左心室肥厚,舒张/收缩功能障碍，心律失常,（前）糖尿病，血脂异常和肠息肉-和恶性肿瘤比年龄和性别匹配的对照组。值得注意的是,在最近的研究中,心血管合并症较低.最常导致肢端肥大症诊断的特征是典型的物理变化（肢端增大，面部变化和前兆)，局部肿瘤影响（头痛和视觉缺陷），糖尿病,甲状腺癌和月经失调。
结论：肢端肥大症表现为典型的物理变化，但也导致各种常见的合并症，强调识别这些特征的组合是建立诊断的关键。
