Clinical characteristics of acromegaly in Hong Kong

This study analyses the clinical characteristics of acromegalic patients in Hong Kong. All patients with acromegaly under follow up in Prince of Wales Hospital, Hong Kong between January 1984 and December 1992 were reviewed r etrospectively. Detailed hospital notes were available for review in 28 out of 34. Of the 28 patients with full records available, 27 were Chinese and 1 was Nepalese. There were 8 (28.6%) males and 20 (71.4%) females. The mea n age (+/- SD) at presentation was 51.2 +/- 16.8 years (range: 28 to 84 yea rs) (male, 49.9 +/- 13.9 years [range: 28-66]; female, 51.7 +/- 18.1 years [range: 31-84]; p-value: NS). The commonest mode of presentation (n=22, 78. 6%) was clinical suspicion by medical staff during consultation for other c onditions, acromegaly being later confirmed. The estimated duration of symp toms, before diagnosis, was 14 years (range: 1 to 30 years). CT scan imagin g of the pituitary gland showed that 12 patients (42.9%) had pituitary macr o-adenomas (greater than or equal to 1 cm), 3 (10.7%) had micro-adenomas (< 1 cm), 6 (21.4%) had normal imaging, 1 (3.6%) had an empty sella and 6 (21. 4%) had suspicious but inconclusive lesions in the pituitary gland. Surgery was offered as initial treatment to all patients. 4 to 6 weeks afte r surgery, if the maximal growth hormone response following glucose loading exceeded 10 mu g/L, radiotherapy was offered. Of the 28 patients, 13 recei ved surgery and radiotherapy, 2 surgery only, 4 radiotherapy only, 4 no tre atment and 5 defaulted. At presentation, 50% had some abnormality of glucos e tolerance. The mean early morning fasting baseline growth hormone was 52. 8 +/- 37.0 mu g/L (mean +/- SD, median: 48.1 mu g/L) and the maximal growth hormone response during an extended oral glucose tolerance test was 63.2 /- 34.9 mu g/L (median: 61.3 mu g/L). Forty five percents of patients had a maximal growth hormone response exceeding 60 mu g/L. Of the 19 patients wh o underwent surgery and/or radiotherapy, 15 had their pituitary function re assessed 6 months after intervention. Their early morning fasting growth ho rmone and maximal growth hormone response in an extended oral glucose toler ance test were 21.3 +/- 25.8 and 35.4 +/- 37.5 mu g/L, respectively. In con clusion, acromegaly in I-long Kong has an estimated annual incidence of 3.8 per million. There is a female preponderance, tendency to late presentatio n (>10 years) and low number of large tumors. Up to 80% were referred follo wing observer suspicion.