Date of this Version

1-1-2022

Document Type

Article

Abstract

Context: Acromegaly (ACM) and Cushing's disease (CD) are caused by functioning pituitary adenomas secreting growth hormone and ACTH respectively. Objective: To determine the impact of race on presentation and postoperative outcomes in adults with ACM and CD, which has not yet been evaluated. Methods: This is a retrospective study of consecutive patients operated at a large-volume pituitary center. We evaluated (1) racial distribution of patients residing in the metropolitan area (Metro, N=124) vs 2010 US census data, and(2) presentation and postoperative outcomes in Black vs White for patients from the entire catchment area (N=241). Results: For Metro area (32.4% Black population), Black patients represented 16.75% ACM (P=.006) and 29.2% CD (P=.56). Among the total 112 patients with ACM, presentations with headaches or incidentaloma were more common in Black patients (76.9% vs 31% White, P=.01). Black patients had a higher prevalence of diabetes (54% vs 16% White, P=.005), significantly lower interferon insulin-like growth factor (IGF)-1 deviation from normal (P=.03) and borderline lower median growth hormone levels (P=.09). Mean tumor diameter and proportion of tumors with cavernous sinus invasion were similar. Three-month biochemical remission (46% Black, 55% White, P=.76) and long-term IGF-1 control by multimodality therapy (92.3% Black, 80.5% White, P=.45) were similar. Among the total 129 patients with CD, Black patients had more hypopituitarism (69% vs 45% White, P=.04) and macroadenomas (33% vs 15% White, P=.05). At 3 months, remission rate was borderline higher in White (92% vs 78% Black, P=0.08), which was attributed to macroadenomas by logistic regression. Conclusion: We identified disparities regarding racial distribution, and clinical and biochemical characteristics in ACM, suggesting late or missed diagnosis in Black patients. Large nationwide studies are necessary to confirm our findings.

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