Long-term facial changes and clinical correlations in patients with treated acromegaly: a cohort study

Abstract

Background: Facial abnormality is the most significant feature in acromegaly patients. However, it is unclear whether and how patient facial appearance improves after treatment. This study aimed to identify 3D facial changes in acromegaly patients after surgical treatment. Methods: This study included 30 acromegaly patients who underwent resection of a pituitary GH adenoma. The location and extent of facial changes were identified by comparing baseline and 2-year follow-up 3D images of the face. Relationships between facial changes and GH and IGF-1 were evaluated with simple or multivariable linear regression models. Results: Significant soft tissue improvements were observed in acromegaly patients with complete remission, especially in the nose and lip region. Significant reductions in nasal width (3.46 mm, p < 0.001), tip protrusion (1.18 mm, p=0.003), face curve length (3.89 mm, p=0.004) and vermilion area (1.42 cm3, p=0.001) were observed at the 2-year follow-up. Further, changes in nasal width were associated with decreases in GH (β=4.440, p=0.017), the GH nadir (β=4.393, p=0.011) and IGF-1 (β=5.263, p=0.002). The associations were maintained after adjusting for confounders. Conclusions: Acromegaly patients achieved considerable facial improvements after surgical treatment. The change in nose width was associated with GH and IGF-1 decreases. Better control of patient hormone levels after surgery improves patient facial recovery.

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

“…We found greater facial morphometric differences in men than in women, especially in the post-diagnosis phase, as also evidenced by different reports, which con rm that the morphometric progression is irreversible and show a sexual dimorphism [21,23,24]. Likewise, other ndings con rm that morphometric modi cations remained signi cantly altered two years after remission in cured patients [25,26], as we did in the present work. The scoring process carried out by endocrinologists showed a high intraclass correlation coe cient, which additionally opens new lines of research with the creation of an arti cial intelligence software system through 3D images that can establish an early diagnosis in acromegalic patients.…”

Evaluating the Impact of Acromegaly on Quality of Life

“…These features significantly improve after the reversal of GH excess but do not always completely normalize. [64][65][66] Morphometric changes significantly correlate with poor psychological outcomes in acromegaly patients, and it is extremely important to address this subject during consultation. 40,67 GH-induced vocal changes are also frequently reported during active disease, although mucosal edema and hypertrophy largely resolve during treatment with the improvement of symptoms, voice complaints persist in a subset of patients.…”

Neue Entwicklungen und Perspektiven in der Akromegalie

“…Mit Blick auf die veränderten Gesichtsmerkmale wurden in einer weiteren chinesischen Untersuchung 30 Akromegalie-Patienten vor und 2 Jahre nach einer Hypophysenoperation untersucht [5]. Bei postoperativ kompletter Remission zeigte sich eine deutliche Rückbildung der markanten Gesichtszüge (v. a. in Bezug auf Nasenbreite und Lippengröße), die z. T. auch mit dem Rückgang von GH und IGF-1 korrelierte.…”