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A familiar story

John Ayuk   (23 October 2007)

Acromegaly

Cordelia Phelan   (19 November 2007)

A familiar story 23 October 2007
John Ayuk, Consultant Endocrinologist Department of Medicine, Queen Elizabeth Hospital, Edgbaston, Birmingham, B15 2TH Send response to journal: Re: A familiar story	Dear Editor Reading through Jon Danzig’s excellent article triggered feelings of déjà vu[1]. Physicians dealing with patients with acromegaly will tell you they hear stories like this time and time again; the vague, seemingly disparate collection of symptoms leading the patient to consult various healthcare professionals over the years till the penny finally drops and the diagnosis of acromegaly is made. As Mr Danzig so clearly articulates, it is a frustrating experience for both the patient and the healthcare professionals involved. However, we should not be too harsh in our judgement of his general practitioner, especially given the way he has responded to what was clearly a difficult and uncomfortable situation to be in. Acromegaly is a rare condition, with an estimated prevalence of around 60 per million and an annual incidence of 3-4 per million[2], so the average general practitioner is unlikely to come across more than one patient with acromegaly on his/her surgery list. The clinical features of acromegaly often develop insidiously over many years and few patients present immediately at the time of onset of symptoms, resulting in delayed diagnosis[3]. In fact, the most common mode of presentation is as an incidental finding by a healthcare professional[4], and we often receive referrals from medical practitioners who notice features suggestive of acromegaly in a family member accompanying the patient they are dealing with. Fortunately, this difficult episode ended on a more positive note, and given the individuals involved, I am certain Mr Danzig is receiving excellent care for his acromegaly. I have no evidence to prove it as yet, but I (and others) do believe that due to increased awareness and a higher index of suspicion amongst healthcare professionals, we are diagnosing patients with acromegaly earlier than in previous times. Hopefully, in the future, stories like this will become the exception, rather than the norm. Reference List 1. Danzig J. Acromegaly. BMJ 2007;335:824-825. 2. Holdaway IM , Rajasoorya C. Epidemiology of acromegaly. Pituitary. 1999;2:29-41. 3. Nabarro JD. Acromegaly. Clin.Endocrinol.(Oxf) 1987;26:481-512. 4. Duncan E , Wass JA. Investigation protocol: acromegaly and its investigation. Clin.Endocrinol.(Oxf) 1999;50:285-293. Competing interests: None declared
Acromegaly 19 November 2007
Cordelia Phelan, Consultant Histopathologist University Hospital of North Staffordshire, ST4 6QR Send response to journal: Re: Acromegaly	I found the article about acromegaly from the patient's point of view fascinating and at the same time very disappointing. The patient lost years of his life due to delayed diagnosis. When I read the article I could see the sign on my GP's door saying: "Only one problem per consultation!". How is a GP supposed to make a diagnosis of a syndrome if the patient is only allowed to complain about one sympton? The obvious problem is that GPs don't have enough time and only plan 5 minutes per consultation. However, not allowing the patient to mention more than one symptom does not seem to be the answer. Competing interests: None declared