Prevalence of Acromegaly in Canada
The prevalence of acromegaly in Canada is estimated to be approximately 60 per million people, with an annual incidence of 3-4 cases per million per year. 1
Epidemiological Data on Acromegaly
General Prevalence and Incidence
- Acromegaly is a rare disease with prevalence rates varying by geographical region, ranging from 2.8 to 13.7 cases per 100,000 people (28-137 per million) globally 2
- Annual incidence rates worldwide range between 0.2 and 1.1 cases per 100,000 people 2
- In Canada specifically, the prevalence follows the general pattern seen in other developed countries, with approximately 60 per million population 1
Canadian-Specific Demographics
- There has been an increase in referrals for acromegaly management in Canada over the past decades 3
- In recent years (post-1995), there has been a female preponderance (52.8% vs 41.4% before 1995) among diagnosed cases in Canada 3
- The average age at diagnosis in Canada has increased over time, with more recent data showing diagnosis at 46.4 ± 14 years compared to 41.3 ± 12 years in earlier periods 3
Clinical Presentation and Diagnosis
Common Presenting Features
- Acral enlargement and coarse facial features are the most commonly described clinical manifestations 2
- Diagnostic delay is significant, with a median delay of 4.5-5 years from symptom onset to diagnosis 2
- Most tumors are macroadenomas at the time of detection, likely due to diagnostic delays 2
Associated Comorbidities in Canadian Patients
- Diabetes is present in 28% of Canadian acromegaly patients 3
- Hypertension affects 37% of Canadian patients 3
- Sleep apnea is diagnosed in 33% of cases 3
- Higher pretreatment IGF-1 levels are significant predictors of diabetes (p=0.0002) and hypertension (p<0.0001) 3
Management and Outcomes in Canada
Treatment Approaches
- 89% of Canadian acromegaly patients undergo pituitary surgery 3
- 64.5% receive medical therapy 3
- 22% undergo radiotherapy, with a significant decrease in radiotherapy utilization in recent years (16% vs 45% before 1995) 3
- Multimodal therapy achieves remission or control in approximately 70% of Canadian patients 3
Prognostic Factors
- Patients with lower initial random GH (p=0.04) and IGF-1 levels (p<0.0001) have better outcomes in terms of disease remission or control 3
- Hypopituitarism is present in 23% of Canadian acromegaly patients 3
- Cancer is diagnosed in 8.5% of patients 3
Clinical Implications
Screening Recommendations
- Due to increased risk of colorectal neoplasia in acromegaly patients, regular colonoscopic screening is recommended starting at age 40 4
- Total colonoscopy rather than sigmoidoscopy is required for proper screening 4
Treatment Considerations
- Surgical resection is considered the cornerstone of treatment in Canada 5
- Adjunctive therapy is often needed, with options including bromocriptine and octreotide 5
- The goal of treatment should be normalization of both GH and IGF-1 levels to reduce long-term health risks 5
Monitoring and Follow-up
- Persistent elevation of GH and IGF-1 may pose significant long-term health risks 5
- Achieving post-treatment GH levels <2.5 μg/L is necessary to normalize mortality risk 1
Pitfalls and Caveats
- Due to the rarity of acromegaly, diagnosis is often delayed, leading to increased morbidity and mortality 2
- Increased awareness among healthcare providers is essential to reduce diagnostic delays 2
- Even after successful treatment, sequelae such as joint pain, deformities, and altered quality of life often remain 6
- Observed-to-expected mortality ratios range from 1.6-3.3 and only approach normal levels in patients with post-treatment GH levels <2.5 μg/L 1