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Management of acromegaly: an exploratory survey of physicians from the Middle East and North Africa

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Abstract

Background

Worldwide variations exist in the diagnosis and management of patients with acromegaly. For such a rare condition, the knowledge and perception of physicians would most likely direct the care of patients. However, the adherence of physicians in non-Western regions to guidelines for the diagnosis and management of acromegaly has not been previously ascertained.

Methods

An online survey was conducted to assess the perceptions and practice of physicians regarding acromegaly diagnosis and management as per international guidelines. An electronic questionnaire containing key questions was mailed, initially to physicians in Saudi Arabia (KSA) and later to other countries in the Middle East and North Africa (MENA) region. Additional questions were included to ensure the relevance of the respondents’ replies. The responses were captured and summarized anonymously. Descriptive comparisons were made with two similar international and national surveys from other regions.

Results

Two hundred forty-seven doctors responded to the survey. Of these, 155 (64.5%) fulfilled the inclusion criteria and, in particular, confirmed having treated acromegaly patients in the previous 12 months, and they constituted the basis of this study. The three most common referring specialties for patients were internists (44; 28.4%), neurosurgeons (46; 29.6%), and family medicine physicians (42; 27.1%), respectively. The combination of growth hormone (GH) nadir during the oral glucose tolerance test (OGTT) and elevated insulin-like growth factor-1 (IGF-1) levels was used by 99 physicians (63.9%) to diagnose acromegaly. The main determinant for treatment choice was tumor mass characteristics confirmed by 117 respondents (75.5%) with neurosurgery as first treatment choice confirmed by 124 respondents (80%). Combined measurement of IGF-1 and GH levels after OGTT at 3 months after surgery was the most widely used criterion for assessment of surgical outcomes, confirmed by 82 physicians (52.9%). The biggest barriers to optimal management of acromegaly as perceived by 38.1% and 35.5% of the respondents were high cost of medications and lack of physicians’ awareness, respectively.

Conclusions

The majority of the surveyed physicians reported variable adherence to the international acromegaly guidelines. Clearly, higher awareness is needed among physicians for early diagnosis and timely referral for specialist management.

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Acknowledgements

The authors would like to express their sincere gratitude and appreciation to all colleagues who took the time and made the effort to respond to the survey.

Author information

Authors and Affiliations

  1. Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Riyadh, Saudi Arabia

    Maswood M. Ahmad, Badurudeen Mahmood Buhary, Imad Brema & Mussa H. AlMalki

  2. Faculty of Medicine, King Saud Bin Abdul Aziz University of Health Sciences, Riyadh, Saudi Arabia

    Fatima Al Mousawi

  3. King Abdul Aziz Medical City, College of Medicine, King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia

    Fahad Alshahrani

  4. Department of Endocrinology, Tawam Hospital, Al Ain, United Arab Emirates

    Khalid M. Al Dahmani

  5. Department of Endocrinology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates

    Salem A. Beshyah & Mussa H. AlMalki

Authors
  1. Maswood M. Ahmad
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  2. Badurudeen Mahmood Buhary
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  3. Fatima Al Mousawi
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  4. Fahad Alshahrani
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  5. Imad Brema
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  6. Khalid M. Al Dahmani
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  7. Salem A. Beshyah
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  8. Mussa H. AlMalki
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Contributions

All authors contributed to the conception, planning, and conduct of the study, drafting, and revising of the manuscript and approval of its final version.

Corresponding author

Correspondence to Salem A. Beshyah.

Ethics declarations

Despite the absence of human risk, local regulations stipulate that all surveys be approved by an ethical review board. Hence, ethical approval was secured from two IRBs in KSA and the United Arab Emirates (UAE) as per the local requirements. Additionally, all respondents gave informed consent (electronically) before they could proceed to take the questionnaire.

Conflict of interest

The authors declare that they have no conflict of interest.

Human and animal rights

No human or animal studies by the authors were reported.

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Ahmad, M.M., Buhary, B.M., Al Mousawi, F. et al. Management of acromegaly: an exploratory survey of physicians from the Middle East and North Africa. Hormones 17, 373–381 (2018). https://doi.org/10.1007/s42000-018-0045-1

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  • DOI: https://doi.org/10.1007/s42000-018-0045-1

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