Body Image Perception in Acromegaly Is Not Associated with Objective Acromegalic Changes but Depends on Depressive Symptoms

Abstract

Objective: Diagnosis of acromegaly is delayed up to 10 years after disease onset despite obvious external/objective changes such as bone and soft tissue deformities. We hypothesized that a lack of subjective perception of the disease state, possibly mediated by psychiatric or cognitive alterations, might contribute to the delayed initiation of a diagnostic workup. Design: Cross-sectional study. Methods: We investigated perceived body image by standardized questionnaires (FKB-20: Fragebogen zum Körperbild; FBeK: Fragebogen zur Beurteilung des eigenen Körpers) in 81 acromegalic patients and contrasted them to (a) a clinical control group of 60 patients with nonfunctioning pituitary adenomas (NFPA) who lack severe facial and physical alterations and (b) healthy controls. We further evaluated body image in relation to objective acromegalic changes as judged by medical experts and psychiatric pathology, e.g. depression and cognitive impairment. Results: Patients with acromegaly did not lack subjective perception of the disease state; they showed more negative body image, less vitality, more insecurity/paresthesia and more accentuation of the body compared to normal controls. NFPA patients differed from acromegalic patients only in the ‘vital body dynamics' scale of the FKB-20, although they hardly exhibit any physical/bodily changes. Depression correlated with worse body image. No associations were found between body image and objective acromegalic changes as judged by medical experts, cognitive decline or treatment status. Conclusions: Negative body image in acromegalic patients is unrelated to their objective appearance and similar to those of NFPA patients without major bodily changes. Depression, but not cognitive decline or treatment status, contributes to negative body image.

Variables Associated With Body Image Concerns in Acromegaly Patients: A Cross-Sectional Study

“…Our findings are generally consistent with previous research on body image concerns in patients with acromegaly (Conaglen et al, 2015). However, our findings differ from those of previous studies regarding the association between anxiety, depression, and body image concerns (Dimopoulou et al, 2017). Previous studies suggest that body image perception in acromegaly correlates with depressive symptoms.…”

Facial Phenotype Changes and Its Impact in Quality of Life of Acromegaly Patients

“…The fact of having a rm diagnosis allowing a pharmacological and/or surgical treatment which has a positive in uence in the disease is felt as a gain, but it does not affect QoL. The present study also shows that patients present moderate to high levels of self-esteem, as also reported by Dimopoulu et al [22]. Changes at the facial level in acromegalic patients occur slowly and progressively, with people adapting to modi cations and accommodating its perception under a state of self-image acceptance.…”

Clinical features and complications of acromegaly at diagnosis are not all the same: data from two large referral centers

“…These differences between symptoms and signs are in accordance with previous studies ( 12 ) that demonstrated up to 40% differences at the time of first presentation. Some authors suggest that the perceived body changes in acromegaly are less related to objective findings at the physical exam but more related to depressive symptoms ( 27 ). A recent study of the oro-dental state in acromegalic patients also reported a discrepancy between a relatively good objective exam and unsatisfactory self-assessment of oral health-related QoL ( 28 ).…”