A total of 25 cases of acromegaly were recorded. The mean age of the patients was 42.5 ± 12 years, with extremes of 25 and 69 years. There were 10 females and 15 males, giving a sex ratio of 1.5. Our patients were housewives (7 cases, 28%), manual workers (6 cases, 24%), civil servants (5 cases, 20%), shopkeepers (4 cases, 16%) and students (3 cases, 12%). Approximately 48% of our patients came from the country’s capital, Dakar (12 cases), 33% from other regions of Senegal (8 cases) and 20% from neighbouring countries such as Guinea, Gambia and Mauritania (5 cases). In our series, 80% of patients were married (20 cases) and the average number of children per patient was 4.3. Only 4 married patients had no children.

Table 1 shows the distribution according to socio-demographic characteristics.

Table 1. Breakdown by socio-demographic characteristics.

3.2.1. Circumstances of Discovery

The main circumstances of discovery were craniofacial dysmorphia (9 cases, 36%), diabetes mellitus (11 cases, 44%) and arterial hypertension (10 cases, 40%). One patient was previously treated for Behçet’s disease (4%) and two others for goiter (8%).

3.2.2. Tumor Syndrome

On examination, all patients presented at least one sign related to the tumor syndrome. These included chronic headache in 22 cases (88%), ringing in the ears in 21 cases (84%) and vertigo in 10 cases (40%). In terms of ophthalmology, we found reduced visual acuity in 17 cases (68%), photophobia in 17 cases (68%) and nystagmus in 01 cases (4%).

3.2.3. Secretory Syndrome

It was present in all patients. On average, weight was 96 ± 12 kg (extremes 75 and 120 kg), height 180 ± 13 cm (extremes 153 and 209 cm) and body mass index (BMI) 29.6 ± 4.6 kg/m² (extremes 22.8 and 41.7 kg/m²). According to BMI, obesity was present in 10 cases (40%), overweight in 13 (52%). Arterial hypertension was present in 10 patients (40%). Gigantism was present in 13 patients (52%).

Among our patients, 24 cases (96%) had at least one organomegaly. These included 24 cases of macroglossia (96%), 2 cases of goiter (8%). There was no cardiomegaly, hepatomegaly or splenomegaly. The main signs of dysmorphic syndrome were prognathism (100%), protruding cheekbones (100%), thickened lips (100%), macroglossia (100%), enlarged extremities (100%), dysphonia (92%), sinus pneumatization (92%), marked wrinkles (92%). Other clinical signs related to prolactin hypersecretion were found. These included galactorrhea (7 cases, 28%), gynecomastia (5 cases, 20%), decreased libido and erectile dysfunction (7 cases, 28%), amenorrhea (3 cases, 12%). Table 2 shows the distribution according to pituitary clinical syndromes.

Table 2. Distribution of patients by pituitary clinical syndromes.

3.3.1. Biological Data

The various growth hormones were increased in all patients. On average, plasma IGF-1 levels were 610.7 ± 218 ng/ml (extremes 263 and 1079) and GH 61.3 ng/ml (extremes 7 and 150). Hyperprolactinemia > 100 ng/ml was found in 09 patients (36%). Other hormonal abnormalities were corticotropic insufficiency in 3 cases (12%), thyrotropic insufficiency in 04 cases (16%) and gonadotropic insufficiency in 06 cases (24%). Phosphocalcic and ionic tests were normal in all our patients.

3.3.2. Morphological Data

Magnetic resonance imaging was performed in all patients. There were 20 cases of macroadenoma (80%), 5 cases of microadenoma (20%), 12 cases of extension (48%). This extension was cavernous (4 cases, 16%), chiasmatic (2 cases, 8%), chiasmo-cavernous (6 cases, 24%). The extension concerned only pituitary macroadenomas, where the mean GH level was 68.8 ng/ml and IGF-1 608.6 ng/ml. Abdominal and pelvic ultrasound was performed in 19 patients, including a single case of prostatic hypertrophy. Cardiac ultrasound in 18 patients revealed 4 cases of hypertrophic cardiomyopathy and one case of type 1 diastolic dysfunction (see Table 3).

The proportion of patients with isolated acromegaly was 75% (15 subjects). Nevertheless, 25% or 5 cases of mixed adenomas were found (see Table 3).

Table 3. Distribution according to morphological, hormonal and therapeutic data.

All patients had received medical treatment with Cabergoline (Dostinex^®) at an initial dose of 0.5 mg per week. Other medical treatments included antidiabetics and antihypertensives. Somatostatin analogues and GH receptor antagonists were not available in Senegal (see Table 3).

The proportion of patients who had undergone pituitary surgery was 96% (24 cases). This was exclusively trans-sphenoidal surgery. None of our patients underwent radiotherapy. Of the patients who underwent surgery, 30% (6 patients) developed transient diabetes insipidus postoperatively. Other post-operative incidents included epistaxis or rhinorrhea in 5 cases (20.8%), meningitis and pulmonary embolism in 01 cases each. One case of post-operative death was related to pulmonary embolism.

Epidemiological studies presented acromegaly as a rare pathology, with a prevalence ranging from 20 to 80 cases per million inhabitants [13]. In Africa, in the absence of national registries, its frequency depends on the number of cases reported from one series to another [14]-[20]. Because of its insidious nature, diagnosis is often made with considerable delay (4 to 10 years or more). In our series, acromegalia was discovered some 04 years later than the first symptoms. This long delay in diagnosis is directly responsible for the frequency of complications noted in various series, particularly in Africa [18][21]. In the study by Maione et al. [13], the delay in diagnosis was 6.6 years.The mean age of our patients at the time of acromegaly diagnosis (42.5 ± 12 years) was comparable to that of international reviews. Moreover, age at diagnosis was significantly higher in women than in men in all the studies reported [13][16].

In Africa, the few cases of acromegaly reported in the literature describe highly advanced forms, as evidenced by complications, notably metabolic [18]. In our population, acromegaly was revealed by a dysmorphic syndrome and/or a pituitary tumor syndrome in all cases. The prevalence of clinical signs varied from one series to another, depending on how early the diagnosis was made [16][22]. The more chronic and severe the GH excess, the more severe the signs [7].

The disease also has numerous somatic, metabolic, endocrine and cardiac repercussions, all of which affect prognosis. The majority of patients in our series (70%) had already developed complications at the time of diagnosis. These were mainly diabetes mellitus (45%) and hypertension (50%). According to the literature, the incidence of hyperglycemia correlated with the rate of GH secretion and the duration of the condition [23]. The predominance of diabetes and hypertension among the main comorbidities was previously reported among the 16,000 patients from the 19 national registries.In these registries, the prevalence of comorbidities varied from one series to another [13]. According to Anagnostis et al. [24], other morbidities during follow-up were myocardial hypertrophy (50%), colon polyps (55%), thyroid nodules (74%) and an adrenal mass (18%).

Pituitary magnetic resonance imaging remains the gold standard. Pituitary adenomas were found in 95% of cases, and pituitary hyperplasia in 5%. We report a predominance of macroadenomas. In the 19 national acromegaly registries reported by Maione et al. [13] and the South African series by Elbueishi et al. [16], macroadenomas accounted for 75% and 92.5% of cases respectively. 4.3. Therapeutic data.

4.2.1. Medical Treatment

In the systematic review by Maione et al. [13], which included 16,000 patients drawn from 19 national registries, first-line medical treatment was administered in an average of 24% of cases. Most patients were treated with somatostatin analogues, followed by dopaminergic agonists and finally pegvisomant. In our series, in the absence of somatostatin analogues and pegvisomant, 44% of patients had initially benefited from dopaminergic agonists. In a Belgian study of 64 patients treated with Cabergoline (Dostinex), normalization of IGF1 was achieved in 39% of patients with mixed adenomas and moderately elevated initial GH levels [25]. Depending on the study, the efficacy of somatostatin analogues on hormonal control was 6474% in the first few months [26]. A time effect was suggested. Thus, during follow-up (84 months in the study by Cozzi et al. [27] and 18 years in the study by Maiza et al. [28]), IGF-1 concentration would continue to fall while the same dose of somatostatin analogues was continued. It should be noted that the efficacy of this treatment varies from study to study, probably due to differences in treatment duration, patient selection and the existence or absence of a history of surgery or radiotherapy. Finally, the expression of receptor subtypes by the tumor probably also plays a role [13].

GH antagonists are the medical treatment with the fastest and most consistent effect on symptoms. In clinical trials, after 12 weeks of treatment, the percentage of patients normalized reached 90% [29][30]. Unfortunately, this drug is not yet available in Senegal.

4.2.2. Surgical Treatment

Given the unavailability of somatostatin analogues in Senegal, the proportion of our patients operated on was 96%. Elsewhere, the weighted mean percentage of cases operated on was 80.4%, and was relatively stable across countries (ranging from 67% to 96.3%) [13][16]. The surgical success rate alone has not changed over time, indicating stability in neurosurgical performance, despite the introduction of new techniques [31][32]. This is also linked to the persistence of a high prevalence of macroadenomas at diagnosis, which is a major predictor of surgical outcome [13]. Intraoperative complications.

In our series, 04 patients presented with transient diabetes insipidus. Shah et al. [33] reported a rate of 7.6% transient diabetes insipidus and 3.8% definite diabetes insipidus in the endoscopic surgery group, compared with 20% transient diabetes insipidus and 7.2% definite diabetes insipidus in the microscopic surgery group. Other incidents were mainly bleeding (6 cases), cerebrospinal fluid leakage (5 cases), rhinorrhea (4 cases) and epistaxis (4 cases). Two cases of death were recorded, one by pulmonary embolism and the other by pituitary apoplexy.

According to Zhu et al. [34], this rate was observed in 4.8% of pituitary macroadenomas.