Quality of Life in Patients with Acromegaly before and after Transsphenoidal Surgical Resection

Abstract

Objective. We aimed to determine the perioperative changes in the quality of life (QoL) in patients with acromegaly and to reveal the relationship between biochemical indicators and quality of life change after tumor resection. Methods. Patients with acromegaly were enrolled from a tertiary pituitary center. SF-36 scale and AcroQoL scale were used to determine the QoL before and after surgery. We analyzed changes in QoL using a generalized linear model for repeated measurements. We compared the changes in QoL among three groups (remission, active, and discordant group) based on postoperative growth hormone (GH) and insulin-like growth factor-1. Results. 151 patients (75 males and 76 females) diagnosed with acromegaly were included. The average age was 43.9 ± 12.3 years. The median total SF-36 scale was 65.3% (IQR: 63.2%–69.2%). Overall AcroQoL score at baseline was 59.1% (IQR: 51.8%–71.8%). Nadir GH levels (coefficient −0.08, p=0.047), T3 levels (coefficient 2.8, p=0.001), and testosterone levels (coefficient −0.20, p=0.033) in males were independent predictive factors of the total SF-36 score. During the follow-up, the median overall SF-36 score increased to 66.1% at 3 months and 75.3% at 6 months (p<0.001) after surgery. The median overall AcroQoL score increased to 74.5% at 3 months and 77.3% at 6 months (p<0.001) after surgery. At 6-month follow-up, median scores were still less than 70% in appearance, vitality, and mental health dimensions. The QoL after surgery were similar among the three groups, although higher GH and more preoperative somatostatin analogs usage were observed in the active group. Conclusion. In conclusion, acromegalic patients were associated with low QoL, which could be reversed partially by surgery. The improvement was independent of the endocrine remission. Appearance, vitality, and mental health were three major aspects that warrant further attention from physicians and caregivers after surgery.

Correlation Between Clinical and Biochemical Markers in Patients With Acromegaly on Different Modalities of Treatment

“…In contrast, other studies show a different view; in Shanghai, China, Gu et al (2020) concluded that improvement in HrQoL was achieved in acromegaly patients treated by transsphenoidal surgery independent of biochemical control [ 24 ]. Negger et al (2008) found in their prospective, double-blind placebo-controlled study on 20 patients on SRLs therapy that there is an improvement in their HrQoL after adding pegvisomant to SRLs with no significant reduction even in patients with controlled baseline IGF-1 level [ 25 ].…”

Patient-reported outcomes in refractory hormone-producing pituitary adenomas: an unmet need

“…1), of which seven reported absolute values. In these seven studies, scores of refractory acromegaly patients compared to patients in remission varied substantially, described as either comparable in the two patient groups in four studies [44][45][46][47], decreased in one study [38], or decreased except for the domain personal relations in another study [48] (Table 1). One study compared refractory acromegaly patients to healthy controls, finding lower scores in all domains for refractory patients [49].…”

“…AcroQoL Acromegaly Quality of Life Questionnaire, IQR interquartile range, SMS( +) on somatostatin analogue treatment, SMS(−) not on somatostatin analogue treatment, ↓ significantly lower compared to acromegaly patients in remission; ↑ significantly higher compared to acromegaly patients in remission, no P-value reported, = tested and no significant difference compared to patients in remission a Patients received octreotide LAR every two weeks (dose not reported) b Psychological subscales c AcroQoL scores did not differ between refractory patients and patients in remission at 24 weeks d No significant difference between all refractory patients SMS (+) or SMS (−) and patients in remission. No subgroup analysis performed for SMS(+) and SMS(−) separately e Refractory patients scored significantly lower than healthy controls f Values estimated based on figure, absolute values were not presented g Patients received weekly intramuscular injections of octreotide LAR 20 mg. At 12 weeks a dose escalation to octreotide LAR 30 mg was permitted in case GH > 2.5 ug/L and/or IGF1 above upper limit of normal for age, but this was not obligatory Chin [47] Gu [44] Guo [38] Hua [46] Psaras [49] Trepp [48] Yamamoto [45] Guo [38] SF-12 Psaras [49] Alcalar [54] Nader [50] d Psaras [49] Vega-Beyhart [52] Ye [53]…”

“…49 [42][43][44][45][46][47][48][49][50][51][52] Role physical 23 [19][20][21][22][23][24][25][26][27][28][29][30] Bodily pain 65 [60][61][62][63][64][65][66][67][68][69][70] General health 28 [22][23][24][25][26][27][28][29][30][31][32][33][34] Social functioning 53 [50][51][52][53][54]…”

Questionnaire and tools: clinical powerful instrument in acromegaly diagnosis and management

“…Another relevant application of the questionnaire is to compare the effects of different treatments. Among the most recent studies in this regard is the one conducted by Gu et al in 2020 [ 10 ]. Designed to evaluate the effectiveness of transsphenoidal neurosurgical therapy on patients’ quality of life, this analysis shows the improvement of patients’ quality of life after surgery, and, additionally, that this enhancement is incomplete and independent from the endocrinological remission of the disease.…”