Global psychological assessment with the evaluation of life and sleep quality and sexual and cognitive function in a large number of patients with acromegaly: a cross-sectional study

Abstract

Objective: Acromegaly is associated with somatic disfigurements which impair self-perception of well-being and quality of life. Nowadays limited data are available on the interplay between hormonal excess and psychological discomfort. The study aimed at investigating the psychological profile, sleep quality, sexual function, cognitive functions, and quality of life in acromegaly. Methods: in 223 acromegaly patients from five referral centres global psychological profile, sleep quality, sexual function, cognitive function, and quality of life were investigated. Results: depression was found in 30% of patients, and anxiety in two-thirds, together with severe discomfort in body image mainly in women. Obstructive sleep apnea syndrome (OSAS)risk and sleep disorders were found in >50% of patients, and daily sleepiness in 20%. Sexual dysfunction was reported in most patients, with the most severe impairment in women. Cognitive functions were compromised in 10% of cases. Disease duration, patient age and gender were the main determinants of such psychological effects. Depression (p=0.047), somatic affective mood lowering (p=0.021), state (p<0.001) and trait (p=0.013) anxiety, and body image distortion at Body Uneasiness Test (BUT) A (p<0.001) and B (p=0.006) were significantly worsened in patients <45 years, and slightly worsen in those diagnosed <2 years before. International Index for Erectile Function (IIEF)-15 (p<0.001) and Female Sexual Function Index (FSFI) (p<0.001) scores were significantly worsened in patients >64 years and slightly worsened in those diagnosed >10 years before, particularly in presence of cardiometabolic and respiratory complications. Cognitive symptoms were slightly worsened in older patients and in those with long disease. Conclusions: Acromegaly is associated with a relevant impairment of psychological profile persisting despite remission and long-term medical treatment.

Cognitive Dysfunction, an Increasingly Valued Long-Term Impairment in Acromegaly

“…In the recent decade, cumulative studies have provided different perspectives for the investigation of cognitive impairment in acromegalic patients at various disease stages—from the naïve status, under therapeutic options, to controlled or even long-term remission [ 17 , 18 , 19 ]. Nevertheless, conflicting outcomes have emerged regarding cognitive functions.…”

“…In two studies with a heterogeneous population of acromegaly patients, the prevalence rate of cognitive impairment varied between 10 and 72% [ 19 , 27 ]. In a cross-sectional study of 55 patients with acromegaly [ 27 ], Sievers et al found that cognitive impairment was prevalent in patients, with 67.3% of patients not meeting the critical levels on at least one test; more specifically, up to 33.3% had impaired attention, 24.1% had memory impairment, and 16.7% had poor executive function performance.…”

“…To date, the largest investigation of cognitive function in acromegaly that has been carried out involved 223 patients from five referral centers in Italy [ 19 ]. All the patients had undergone surgery or were under medical treatment.…”

“…This implies that acromegaly poses a greater risk for cognitive function and daily living as well as heightens the possibility of malnutrition in older adults. Pivonello et al [ 19 ] also showed that disease duration and patient age were among the main determinants of these mental force conditions, with worsening cognitive symptoms for patients with a disease duration of more than 10 years and older patients. Likewise, slightly younger patients have been found to commonly have problems with visuospatial and verbal memory.…”

“…In addition, patients with comorbid obstructive sleep apnea syndrome have exhibited significantly impaired attention [ 19 ]. Wennberg et al [ 32 ] found an association between sleep quality, somnolence, and cognitive performance in 67 patients with acromegaly.…”