MON-268 Factors Associated With QoL Impairment In Patients With Acromegaly In The Elderly

Abstract

Background: With rapid aging in the society and the improvement of prognosis in patients with acromegaly, treatment goals have been changed. In elderly patients with acromegaly, improvement in the quality of life (QoL) is one of the most important treatment goals. However, factors associated with QoL in elderly patients with acromegaly remains unclear. Objective: To clarify the differences in the QoL in patients with acromegaly between the young and elderly, and to identify the factors associated with the impairment in the elderly. Patients and Methods: This is a retrospective cross-sectional single-center study. Eighty patients with acromegaly (male 49%, the mean age 59.6±12.6 years, mean IGF-I SD score 0.7±2.3), who had been followed up in the outpatient clinic at Kobe University Hospital, were enrolled. Patients were divided into following 2 groups; Elderly group (E group); 65 years of age or more (n =34, male 41%, mean age 71.4±4.1 years), or Young group (Y group); younger than 65 years old (n =46, male 50.9%, mean age 50.9±9.2 years). We evaluated QoL using AcroQoL and analyzed the associated factors by multivariate analysis. Results: In the comparison of E and Y group, IGF-I SD score (0.4±1.6 in E group vs. 0.9±2.7 in Y group) and the way of treatment (surgery; 65% vs 72%, current medical therapy; 56% vs 43%, past radiation therapy; 15% vs 9%) were comparable, while disease duration was longer in E than Y group (13.7±10.9 vs 8.3±8.1 years, p =0.02). Arthropathy was more frequent in E group (50% vs 11%, p <0.01).In total, current medical therapy and hydrocortisone replacement were associated with lower total scale (β =-0.27, p =0.01 and β =-0.35, p <0.01). Then, we separately analyzed the associated factors in each E and Y group. In Y group, current medical therapy and hydrocortisone replacement were associated with lower total (β =-0.48, p <0.01, and β =-0.35, p <0.01) and physical scales (β =-0.40, p <0.01, and β =-0.31, p <0.01). Past radiotherapy for the pituitary tumor was also associated with lower mental scale (β =-0.40, p <0.01). On the other hand, in E group, arthropathy and high BMI were associated with lower total scale (β =-0.41, p =0.02, and β =-0.40, p =0.02) and current hydrocortisone replacement was associated with lower physical scale (β =-0.36, p =0.03). Conclusions: AcroQoL score was impaired both in E and Y group in patients with acromegaly. In total, current medical therapy and hydrocortisone replacement were associated with lower QoL scale as previously reported; however, when stratified by age, arthropathy and high BMI were associated with lower QoL scale in the elderly. These data clearly indicate that the factors influence on QoL are different depending on the age. Although causal relationship remains unclarified, these data suggest that when treat the patients, it may be important to avoid these complications.