Abstract
BackgroundInsidious-onset acromegaly may easily be overlooked by non-specialists of acromegaly and cause diagnostic delay. This study aims to examine the association between diagnostic delay and advice from doctors before any confirmed diagnosis and subsequent comorbidities, and elicit patient-perceived reasons for misdiagnoses.MethodsAn online nationwide cross-sectional study was conducted through China Acromegaly Patient Association. Growth Hormone (GH) and Insulin-like Growth Factor 1 (IGF-1) levels at diagnosis and cancerous, endocrine-metabolic, musculoskeletal, cardiovascular, respiratory, and psychiatric comorbidities were reported by patients. The association between diagnostic delay and pre-diagnostic advice from doctors as well as subsequent comorbidities after diagnosis were examined.ResultsIn total, 447 valid responses were collected. Overall, 58.8% patients experienced misdiagnoses, and 22.6% had diagnostic delay. Before arriving at any diagnosis, patients without treatment (adjusted odds ratio [AOR]: 3.66, 95% confidence interval [CI]: 1.30-10.33) or receiving treatment to symptoms only (AOR: 7.05, 95%CI: 4.09-12.17) had greater chance of being misdiagnosed, and hence had diagnostic delay. Patients believed insufficient specialists, limited awareness of acromegaly of non-specialists and poor doctor-patient communications were major reasons of misdiagnosis. Diagnostic delay were associated with higher GH level at diagnosis and endocrine-metabolic, musculoskeletal and cardiovascular comorbidities (all P<0.05).ConclusionsSuboptimal pre-diagnostic advice for patients, reflecting limited awareness of acromegaly among non-specialists, may delay the diagnosis and increase comorbidities. Feedbacks on the patients’ final diagnosis from specialists to non-specialists should be considered, and doctor-patient communication and clinical decision-making process should be improved. Comorbidities should be screened and monitored particularly for patients with diagnostic delay.
Highlights
Is a rare chronic condition caused by the excessive secretion of Growth Hormone (GH) and Insulin-like Growth Factor 1 (IGF-1) [1]
This study aimed to examine the association between diagnostic durations and comorbidities after diagnosis, as no study of this scale has been performed in China
454 adults were diagnosed with acromegaly while others who were diagnosed with pituitary gigantism were excluded
Summary
Is a rare chronic condition caused by the excessive secretion of Growth Hormone (GH) and Insulin-like Growth Factor 1 (IGF-1) [1]. The insidious onset of these symptoms and the overlapping clinical manifestations with other common conditions increases the risk of the condition being overlooked in medical consultations, especially by doctors who are not specialists in this area [5, 6]. This results in difficulties in diagnosing acromegaly which may eventually cause misdiagnosis and lengthy durations before diagnosis that last for approximately 4.5–5 years from symptom onset to the diagnosis of acromegaly [7, 8]. This study aims to examine the association between diagnostic delay and advice from doctors before any confirmed diagnosis and subsequent comorbidities, and elicit patient-perceived reasons for misdiagnoses
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