The incidence and prevalence of acromegaly, a nationwide study from 1955 through 2013.

CONTEXT: Acromegaly is a rare disease with complications and increased mortality. The incidence and prevalence of acromegaly worldwide is not well known. OBJECTIVE: To gather information on patients diagnosed with acromegly in Iceland over 59 years. DESIGN: Information was retrospectively gathered about patients diagnosed with acromegaly from 1955 through 2013. Incidence was calculated from the total Icelandic population. SETTING/PATIENTS: Information was gathered from medical records at Landspitali National University Hospital, Iceland, housing the only endocrine department in the country, at the largest hospital outside of Reykjavik (Sjúkrahúsið á Akureyri, Akureyri Hospital) and the largest private outpatient clinic in Reykjavik, where some of the patients received follow-up care. Further, information on patients were sought from all endocrinologists treating adult patients in Iceland. All patients diagnosed with acromegaly during the study period were included. RESULTS: Fifty-two patients (32 men) were diagnosed during the study period. The average age at diagnosis was 44.5 years. Nine patients had died. Symptoms had been present for more than 3 years in most cases. Twenty-five patients had hypertension (48 %). Follow up information was available for 48 patients, 63 % were considered cured after treatment. CONCLUSIONS: The incidence of acromegaly in Iceland during the study period was much higher than earlier reports have indicated. During the last 9 years of the study 7.7 patients were diagnosed per million per year. At diagnosis, 38 % had developed hypertension and 10 % were diagnosed during follow up. This indicates the importance of endocrine disorders in the aetiology of hypertension.

[Old people in the Emergency Department; Icelandic results from the InterRAI multinational ED study]. / Eldra fólk á brádadeild: íslenskar nidurstödur úr fjölþjódarannsókn InterRAI.

INTRODUCTION: Old people attend emergency departments (ED´s) in increasing numbers. Old people have age related changes in all organ systems and tend to have multiple chronic diseases, be on multiple medications and often have physical and cognitive functional impairments. Hence, they have complex health and social service needs. The purpose of this study was to describe function and geriatric syndromes of old people who present at Landspitali Emergency Department, Iceland, with comparison to ED´s in six other countries. MATERIAL AND METHODS: A prospective descriptive study of people (>75 year´s) attending ED´s in seven countries, including Iceland. The InterRAI assessment tool for ED´s was used by nurses to assess participants. RESULTS: At Landspitali ED, 202 individuals were assessed, of whom 55% were women. Of the 202 individuals, 34% attended the ED within 90 days and of those 48% lived alone. On admission to the ED, 59% had physical or cognitive functional impairment; 13% had only cognitive impairment and 36% were unable to walk without assistance. Caregiver distress was identified in 28% and 11% felt overwhelming burden. From the ED, 46% were admitted to the hospital. Compared with foreign results greater number of Icelandic participants lived alone and caregiver's distress was slightly higher (28% vs. 18%). Fewer individuals in Iceland were admitted to a hospital and Iceland had higher admission rate to rehabilitation compared with the overall group. CONCLUSION: Geriatric syndromes and functional impairment afflicted majority of old people who attended the Landspitali ED. These observations should be taken into account in ED design and care planning for old people to maximize efficiency, safety and quality.