The prevalence of acromegaly is higher than previously reported: Changes over a three-decade period

Objective: To study time-related changes in the prevalence and patient characteristics of acromegaly, as well as to assess the impact of changes in treatment on disease control. Methods: A total of 107 patients with acromegaly were identified by healthcare registries and subsequently validated by patient chart review over a three-decade period (1992–2021). A systematic literature review focusing on the incidence and prevalence of acromegaly was performed identifying 31 studies. Results: The prevalence of acromegaly significantly increased throughout the study period (R ² = 0.94, p <.001) and was 122 cases/10 ⁶ persons in 2021 whereas the annual incidence remained constant at 4.6 cases/10 ⁶ persons. The age at the first sign of acromegaly and the age at diagnosis significantly increased during the study period, whereas growth hormone and insulin-like growth factor I decreased. Incidentalomas constituted 32% of all cases diagnosed with acromegaly in the last decade. Primary surgery was used in 93% of all cases, and repeated surgery decreased from 24% to 10% during the three decades. The use of first-generation somatostatin analogues (21%–48%) and second-line medical treatment (4%–20%) increased with a concomitant improvement of biochemical disease control (58%–91%). Conclusion: The prevalence of acromegaly is higher than previously reported and the clinical presentation has shifted towards a milder phenotype. Modern treatment of acromegaly enables individualized treatment and disease control in the majority of patients.