Epidemiology, morbidity and mortality of acromegaly. The epidemiology of acromegaly in Spain

The Spanish acromegaly registry (REA) was established in 1997 by the Spanish Society for Endocrinology and Nutrition; in 2004 data on 1219 patients were included. The prevalence varied between no reported case (in the regions of Aragón, La Rioja and Asturias) and 76 in Euskadi, with a mean prevalence in those regions with reported cases of 36 cases per million inhabitants. A female predominance was observed (60.8%), and a mean age at diagnosis of 45 years. 81% of the patients were operated, 45% irradiated and 65% medically treated (with somatostatin analogs in 68.5% and dopaminergic agonists in 31.4%). The low postoperative cure rate is striking (40.3%), with large oscillations (between 65% and no cure), and raises the question of the convenience of concentrating surgery in those experienced centres. Reported morbidity is high: 39.1% present high blood pressure, 30% diabetes mellitus, 13% obstructive sleep apnea syndrome, 9.5% colon polyps (even though only half the patients underwent colonoscopy), 1.2% colorectal cancer, 3.1% of the women breast cancer and 0.4% lung cancer. Greater mortality was observed in those patients in whom no normal GH or IGF-I had ever been reported, most frequently due to a cardiovascular cause(39.4%); the mean age of death was 60 years. The current challenge is to complete REA with those diagnosed patients but not registered yet, as well as to update the follow-up data in those already registered, for which purpose the collaboration of all the endocrinologists in Spain is required.