ACROSCORE: a new and simple tool for the diagnosis of acromegaly, a rare and underdiagnosed disease

ObjectiveAcromegaly, a disease caused by GH/IGF-I hypersecretion, is associated with a high mortality rate; early recognition is therefore necessary to ensure successful treatment and to avoid comorbidities. We have created a symptom/sign scoring tool (ACROSCORE) for physicians to use to identify acromegaly. DesignTo compare cases of acromegaly diagnosed between 1990 and 2014 against a control group affected by non-GH-secreting pituitary tumours to identify symptoms and signs that are most discriminative for acromegaly. PatientsConfirmed acromegaly patients and patients affected by non-GH-secreting pituitary tumours. MeasurementsIn all patients, signs, symptoms and comorbidities were recorded from medical records and collected using a specifically designed questionnaire. ResultsA total of 194 acromegaly patients [115 women; mean (SD) age 472 (142) years] and 243 patients affected by non-GH-secreting pituitary tumours [131 women; mean (SD) age 458 (158) years] were included. A strong association was observed for type 2/secondary diabetes [odds ratio (OR) 37], hyperhidrosis (OR 61), thyroid hyperplasia (OR 139), colorectal polyps (OR 104), spaced teeth (OR 254) and carpal tunnel syndrome (OR 43). Based on this information, a multivariable logistic model was built and a 14-point scoring system developed. A score of 0 excludes the risk of acromegaly [positive predictive value (PV+) = 06%]; scores 1-5 comprise a grey area; scores >5 indicate that a diagnosis of acromegaly cannot be excluded (PV+ = 461%). ConclusionsOnce validated in independent studies, ACROSCORE may represent a new tool for the clinical screening of acromegaly that can be used by general practitioners and nonendocrinology specialists.