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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.
Highlights
Usually caused by a growth hormone-secreting pituitary adenoma, is characterized by increased levels of growth hormone (GH) and insulin-like growth factor-1 (IGF-1). e prevalence of acromegaly in the general population is about 36 to 125 cases per 1 million [1].e relative risk of death in untreated patients with acromegaly is estimated to be 1.73 compared to the standardized population, which mainly related to cardiovascular, cerebrovascular, and respiratory diseases [2, 3]
We found that all AcroQoL subscales and SF-36 subscales increased, except for the SF-36 vitality, social functioning, and mental health subscales, in which no differences were found at follow-up compared with baseline
We found that the baseline quality of life was associated with the life quality change after surgical resection, suggesting that patients with low quality of life at baseline were more likely to recover after surgery
Summary
E prevalence of acromegaly in the general population is about 36 to 125 cases per 1 million [1]. E relative risk of death in untreated patients with acromegaly is estimated to be 1.73 compared to the standardized population, which mainly related to cardiovascular, cerebrovascular, and respiratory diseases [2, 3]. Data showed that mortality in patients treated in recent years with modern successful therapies is not different from reference population [4,5,6]. Excessive GH secretion can lead to multiple complications, including diabetes mellitus, hypertension, and osteoporosis. All these together significantly affect the quality of life [7]. Multimodality treatments can control the disease in most cases, some irreversible changes, such as bone lesions and joint lesions, may still persist [8, 9]
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