{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T07:30:12Z","timestamp":1785310212750,"version":"3.55.0"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,10,21]],"date-time":"2021-10-21T00:00:00Z","timestamp":1634774400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005150","name":"Chinese Academy of Medical Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005150","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Insidious-onset acromegaly may easily be overlooked by non-specialists of acromegaly and cause diagnostic delay. This study aims to examine the association between diagnostic delay and advice from doctors before any confirmed diagnosis and subsequent comorbidities, and elicit patient-perceived reasons for misdiagnoses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>An online nationwide cross-sectional study was conducted through China Acromegaly Patient Association. Growth Hormone (GH) and Insulin-like Growth Factor 1 (IGF-1) levels at diagnosis and cancerous, endocrine-metabolic, musculoskeletal, cardiovascular, respiratory, and psychiatric comorbidities were reported by patients. The association between diagnostic delay and pre-diagnostic advice from doctors as well as subsequent comorbidities after diagnosis were examined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 447 valid responses were collected. Overall, 58.8% patients experienced misdiagnoses, and 22.6% had diagnostic delay. Before arriving at any diagnosis, patients without treatment (adjusted odds ratio [AOR]: 3.66, 95% confidence interval [CI]: 1.30-10.33) or receiving treatment to symptoms only (AOR: 7.05, 95%CI: 4.09-12.17) had greater chance of being misdiagnosed, and hence had diagnostic delay. Patients believed insufficient specialists, limited awareness of acromegaly of non-specialists and poor doctor-patient communications were major reasons of misdiagnosis. Diagnostic delay were associated with higher GH level at diagnosis and endocrine-metabolic, musculoskeletal and cardiovascular comorbidities (all P&amp;lt;0.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Suboptimal pre-diagnostic advice for patients, reflecting limited awareness of acromegaly among non-specialists, may delay the diagnosis and increase comorbidities. Feedbacks on the patients\u2019 final diagnosis from specialists to non-specialists should be considered, and doctor-patient communication and clinical decision-making process should be improved. Comorbidities should be screened and monitored particularly for patients with diagnostic delay.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2021.704496","type":"journal-article","created":{"date-parts":[[2021,10,21]],"date-time":"2021-10-21T06:40:52Z","timestamp":1634798452000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":11,"title":["Patient-Identified Problems and Influences Associated With Diagnostic Delay of Acromegaly: A Nationwide Cross-Sectional Study"],"prefix":"10.3389","volume":"12","author":[{"given":"Kailu","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaopeng","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siyue","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zihao","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huijuan","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bing","family":"Xing","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuyang","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong","family":"Dong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,10,21]]},"reference":[{"key":"B1","doi-asserted-by":"crossref","DOI":"10.1016\/B978-0-12-804169-7.00015-5","article-title":"Acromegaly","volume-title":"The Pituitary","author":"Melmed","year":"2017"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgz096","article-title":"A Consensus on the Diagnosis and Treatment of Acromegaly Comorbidities: An Update","volume":"105","author":"Giustina","year":"2020","journal-title":"J Clin Endocrinol Metab"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1155\/2012\/540398","article-title":"Clinical Manifestations and Diagnosis of Acromegaly","volume":"2012","author":"Lugo","year":"2012","journal-title":"Int J Endocrinol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1007\/s11102-016-0772-8","article-title":"Acromegaly: Clinical Features at Diagnosis","volume":"20","author":"Vilar","year":"2017","journal-title":"Pituitary"},{"key":"B5","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1186\/s13023-016-0516-x","article-title":"The Risks of Overlooking the Diagnosis of Secreting Pituitary Adenomas","volume":"11","author":"Brue","year":"2016","journal-title":"Orphanet J Rare Dis"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2012.02.018","article-title":"How do Patients With Rare Diseases Experience the Medical Encounter? Exploring Role Behavior and its Impact on Patient\u2013Physician Interaction","volume":"105","author":"Budych","year":"2012","journal-title":"Health Policy"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2009.03667.x","article-title":"Prevalence of Pituitary Adenomas: A Community-Based, Cross-Sectional Study in Banbury (Oxfordshire, Uk)","volume":"72","author":"Fernandez","year":"2010","journal-title":"Clin Endocrinol (Oxf)"},{"key":"B8","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1007\/s11102-016-0754-x","article-title":"Epidemiology of Acromegaly: Review of Population Studies","volume":"20","author":"Lavrentaki","year":"2017","journal-title":"Pituitary"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-20-0019","article-title":"Prolonged Diagnostic Delay in Acromegaly Is Associated With Increased Morbidity and Mortality","volume":"182","author":"Esposito","year":"2020","journal-title":"Eur J Endocrinol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"337","DOI":"10.2147\/IJGM.S169611","article-title":"Acromegaly: A Challenging Condition to Diagnose","volume":"11","author":"AlDallal","year":"2018","journal-title":"Int J Gen Med"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1159\/000506809","article-title":"Patient-Centered Outcomes With Pituitary and Parasellar Disease","volume":"110","author":"Webb","year":"2020","journal-title":"Neuroendocrinology"},{"key":"B12","doi-asserted-by":"publisher","first-page":"57","DOI":"10.17925\/EE.2018.14.2.57","article-title":"Updates in Diagnosis and Treatment of Acromegaly","volume":"14","author":"Zahr","year":"2018","journal-title":"Eur Endocrinol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"53","DOI":"10.2147\/PPA.S56740","article-title":"Patient Perspectives on the Impact of Acromegaly: Results From Individual and Group Interviews","volume":"8","author":"Gurel","year":"2014","journal-title":"Patient Prefer Adherence"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-18-0925","article-title":"Patients\u2019 Perspectives on Acromegaly Diagnostic Delay: A Qualitative Study","volume":"180","author":"Sibeoni","year":"2019","journal-title":"Eur J Endocrinol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"294","DOI":"10.1007\/s11102-012-0420-x","article-title":"A Consensus on the Diagnosis and Treatment of Acromegaly Complications","volume":"16","author":"Melmed","year":"2013","journal-title":"Pituitary"},{"key":"B16","doi-asserted-by":"publisher","first-page":"e0185561","DOI":"10.1371\/journal.pone.0185561","article-title":"Reference Ranges for Serum Insulin-Like Growth Factor I (IGF-I) in Healthy Chinese Adults","volume":"12","author":"Zhu","year":"2017","journal-title":"PloS One"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1007\/s11102-016-0714-5","article-title":"Implementing a Screening Program for Acromegaly in Latin America: Necessity Versus Feasibility","volume":"19","author":"Danilowicz","year":"2016","journal-title":"Pituitary"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2007-2149","article-title":"Changing Patterns in Diagnosis and Therapy of Acromegaly Over Two Decades","volume":"93","author":"Nachtigall","year":"2008","journal-title":"J Clin Endocrinol Metab"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.20945\/2359-3997000000193","article-title":"Determinants of Morbidities and Mortality in Acromegaly","volume":"63","author":"Kasuki","year":"2019","journal-title":"Arch Endocrinol Metab"},{"key":"B20","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1186\/s12875-019-1053-1","article-title":"General Practitioners Referring Patients to Specialists in Tertiary Healthcare: A Qualitative Study","volume":"20","author":"Tzartzas","year":"2019","journal-title":"BMC Fam Pract"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.1999.00324.x","article-title":"Reasons for Outpatient Referrals From Generalists to Specialists","volume":"14","author":"Donohoe","year":"1999","journal-title":"J Gen Internal Med"},{"key":"B22","doi-asserted-by":"publisher","first-page":"343","DOI":"10.7861\/clinmedicine.16-4-343","article-title":"The Thinking Doctor: Clinical Decision Making in Contemporary Medicine","volume":"16","author":"Trimble","year":"2016","journal-title":"Clin Med"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-018-1764-4","article-title":"Signs and Symptoms of Acromegaly at Diagnosis: The Physician\u2019s and the Patient\u2019s Perspectives in the ACRO-POLIS Study","volume":"63","author":"Caron","year":"2019","journal-title":"Endocrine"},{"key":"B24","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1007\/s12020-018-1618-0","article-title":"Screening of Acromegaly in Adults With Obstructive Sleep Apnea: Is It Worthwhile","volume":"61","author":"Attal","year":"2018","journal-title":"Endocrine"},{"key":"B25","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1016\/j.ebiom.2017.12.015","article-title":"Automatic Detection of Acromegaly From Facial Photographs Using Machine Learning Methods","volume":"27","author":"Kong","year":"2018","journal-title":"EBioMedicine"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2011-0237","article-title":"A Novel Approach to the Detection of Acromegaly: Accuracy of Diagnosis by Automatic Face Classification","volume":"96","author":"Schneider","year":"2011","journal-title":"J Clin Endocrinol Metab"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgaa750","article-title":"Quality of Life and its Determinants in Patients With Treated Acromegaly: A Cross-Sectional Nationwide Study in China","volume":"106","author":"Guo","year":"2020","journal-title":"J Clin Endocrinol Metab"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-12-0084","article-title":"Predictors of Morbidity and Mortality in Acromegaly: An Italian Survey","volume":"167","author":"Arosio","year":"2012","journal-title":"Eur J Endocrinol"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2003-031199","article-title":"Factors Influencing Mortality in Acromegaly","volume":"89","author":"Holdaway","year":"2004","journal-title":"J Clin Endocrinol Metab"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1007\/s11102-010-0224-9","article-title":"Thyroid Cancer is the Most Common Cancer Associated With Acromegaly","volume":"13","author":"Gullu","year":"2010","journal-title":"Pituitary"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1530\/endoabs.41.EP890","article-title":"High Incidence of Thyroid Cancer Among Patients With Acromegaly","volume":"21","author":"Kaldrymidis","year":"2016","journal-title":"J BUON"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1210\/er.2018-00166","article-title":"Growth Hormone\u2019s Links to Cancer","volume":"40","author":"Boguszewski","year":"2019","journal-title":"Endocr Rev"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-16-1064","article-title":"Changes in the Management and Comorbidities of Acromegaly Over Three Decades: The French Acromegaly Registry","volume":"176","author":"Maione","year":"2017","journal-title":"Eur J Endocrinol"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1007\/s11102-016-0725-2","article-title":"Challenges in the Diagnosis and Management of Acromegaly: A Focus on Comorbidities","volume":"19","author":"Abreu","year":"2016","journal-title":"Pituitary"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2019.00120","article-title":"Bringing Cardiovascular Comorbidities in Acromegaly to an Update. How Should We Diagnose and Manage Them","volume":"10","author":"Ramos-Levi","year":"2019","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2014.00229","article-title":"Health Outcomes in Acromegaly: Depression and Anxiety are Promising Targets for Improving Reduced Quality of Life","volume":"5","author":"Geraedts","year":"2014","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1007\/s11102-012-0447-z","article-title":"Diagnostic Delay Is Associated With Psychosocial Impairment in Acromegaly","volume":"16","author":"Siegel","year":"2013","journal-title":"Pituitary"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2021.704496\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,21]],"date-time":"2021-10-21T06:40:55Z","timestamp":1634798455000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2021.704496\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,21]]},"references-count":37,"alternative-id":["10.3389\/fendo.2021.704496"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2021.704496","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,21]]},"article-number":"704496"}}