PNA Medical Corner: Quality of Life for Acromegalics

 

ursula kaiserkevin yuenThis month the PNA Medical Corner focuses on an article co-authored by two members of the PNA, Drs. Kevin Yuen and Ursula Kaiser. The study compared the quality of life for groups of acromegaly patients; one that received pharmacological therapy, the other that did not. They conclude that acromegalics who develop growth hormone deficiency have lower quality of life. They found that while pharmacologic or radiotherapy don’t lower a person’s quality of life, their overall quality of life is suboptimal despite biochemical control.

Pituitary. 2022 Apr 27.
doi: 10.1007/s11102-022-01224-0. Online ahead of print.

PMID: 35476257 DOI: 10.1007/s11102-022-01224-0

Abstract:

Purpose: To assess long-term quality of life (QoL) in patients with sustained biochemical control of acromegaly, comparing those receiving vs not receiving pharmacotherapy (primary analysis); to assess change in QoL over time (secondary analysis).

Methods: Cross-sectional study, with a secondary longitudinal component, of 58 patients with biochemically controlled acromegaly. All had participated in studies assessing QoL years previously, after having undergone surgery ± radiotherapy. One cohort received medical therapy [MED (n = 33)]; the other did not [NO-MED (n = 25)]. QoL was assessed by the 36-Item-Short-Form Health Survey (SF-36), Acromegaly Quality of Life Questionnaire (AcroQoL), Gastrointestinal Quality of Life Index (GIQLI), Symptom Questionnaire, and QoL-Assessment of Growth Hormone Deficiency in Adults (QoL-AGHDA).

Results: Mean (± SD) duration of biochemical control was 15.0 ± 6.4 years for MED and 20.4 ± 8.2 years for NO-MED (p = 0.007). 58% of subjects scored < 25% of normal on ≥ 1 SF-36 domain and 32% scored < 25% of normal on ≥ 4 of 8 domains. Comparing MED vs NO-MED and controlling for duration of biochemical control, there were no significant differences in QoL by SF-36, AcroQOL, GIQLI, Symptom Questionnaire, or QoL-AGHDA. Growth hormone deficiency (GHD) but not radiotherapy predicted poorer QoL. In MED, QoL improved over time in three AcroQoL domains and two GIQLI domains. In NO-MED, QoL worsened in two SF-36 domains and two Symptom Questionnaire domains; QoL-AGHDA scores also worsened in subjects with GHD.

Conclusion: A history of acromegaly and development of GHD, but not pharmacologic or radiotherapy, are detrimental to QoL, which remains poor over the long-term despite biochemical control.

Keywords: Acromegaly; Growth hormone deficiency; Quality of life; Radiation therapy.
© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

 

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