Prevalence, comorbidities and treatment outcomes of patients with Acromegaly in Qatar. Running title: Acromegaly in Qatar

Background : Acromegaly is associated with increased morbidity and reduced life expectancy. There are no previously published data on the presentation and management of patients with acromegaly in Qatar. Methods: This retrospective cohort study includes patients with acromegaly managed at Hamad Medical Corporation (HMC) between 1989 and 2024. Results: A total of 58 cases were identified in a population of ~3.05 million, yielding a prevalence of 1.90 per 100,000 (95% CI: 1.41–2.39). The mean age was 45.2±10.9 years, and 65.5% were male. The most common comorbidities were obesity (84.5%), diabetes (53.4%), and hypertension (46.6%). Tumor characteristics showed that 70.7% had macroadenomas and 12.1% had microadenomas, with a median tumor size of 14 mm (range: 11–18 mm). The most frequent histological subtype was GH-secreting adenomas (43.1%), followed by mixed GH & PRL adenomas (10.3%). Transsphenoidal surgery was performed in 87.9% of cases (52.9% at HMC, 47.1% outside Qatar), while 12.1% underwent pituitary radiotherapy. Medical therapy included octreotide (43.1%), cabergoline (32.8%), and pasireotide (1.8%), with no cases receiving pegvisomant. Postoperative MRI showed residual tumors in 41.4%, while 31.0% had no visible tumor, and MRI was not performed in 13.8%. Biochemical assessment indicated persistent disease in 53.4% of patients, while 32.8% achieved disease control, and data was not available for 13.8%. Conclusion: We report a high prevalence of acromegaly and associated comorbidities, and despite a high rate of transsphenoidal surgery, over half of patients have persistent disease, emphasizing the need for improved disease monitoring and treatment strategies in Qatar.