Health Outcomes in Acromegaly: Depression and Anxiety are Promising Targets for Improving Reduced Quality of Life

Abstract

Introduction: Remission criteria of acromegaly are based on biochemical variables, i.e., normalization of increased hormone levels. However, the established reduction in Quality of Life (QoL) is suggested to be independent of biochemical control. The aim of this study was to test which aspects predict QoL best in acromegaly.Methods/design: This is a prospective cohort study in 80 acromegalic patients, with a cross-sectional and longitudinal part. The main outcome measure was health-related QoL, measured by a generic and a disease-specific questionnaire (the SF-36 and AcroQoL). Main predictors were age, gender, biochemical control, disease characteristics, treatment modalities, and psychopathology.Results: Our cohort of 80 acromegalics had a mean age 54.7 ± 12.3 years with an average disease duration of 10.8 ± 10.0 years. Ratio macro-/microadenoma was 54/26. In adjusted mixed method models, we found that psychopathology significantly predicts QoL in acromegaly (in models including the variables age, gender, disease duration, tumor size, basal hormone levels, relevant treatment modalities, and relevant comorbidities), with a higher degree of psychopathology indicating a lower QoL (depression vs. AcroQoL: B = −1.175, p < 0.001, depression vs. SF-36: B = −1.648, p < 0.001, anxiety vs. AcroQoL: B = −0.399, p < 0.001, anxiety vs. SF-36: B = −0.661, p < 0.001). The explained variances demonstrate superiority of psychopathology over biochemical control and other variables in predicting QoL in our models.Discussion: Superiority of psychopathology over biochemical control calls for a more extensive approach regarding diagnosing depression and anxiety in pituitary adenomas to improve QoL. Depressive symptoms and anxiety are modifiable factors that might provide valuable targets for possible future treatment interventions.

Impaired quality of life in patients with treated acromegaly despite long‐term biochemically stable disease: Results from a 5‐years prospective study

“…In contrast with previous studies, which did not demonstrate an association between QoL and biochemical disease status, we showed a positive correlation between baseline AcroQoL scores and duration of GH and IGF‐1 control; and between PGWBS scores and duration of GH control. Duration of IGF‐1 control was found to be predictive of the total AcroQoL and “Personal Relationships” subscale scores at follow‐up, while duration of GH control was predictive of the AcroQoL “Appearance” subscale score.…”

“…21,24 Apart from physical impairment, previous research has shown that depressive symptoms and anxiety are also associated with reduced QoL in patients with acromegaly, suggesting that psychosocial impairment could be a target for improving QoL in acromegaly. 29 In contrast with previous studies, which did not demonstrate an association between QoL and biochemical disease status, 12,15,20,26,29 we showed a positive correlation between baseline AcroQoL scores and duration of GH and IGF-1 control; and between PGWBS scores and duration of GH control. Duration of IGF-1 control was found to be predictive of the total AcroQoL and "Personal Relationships" subscale scores at follow-up, while duration of GH control was predictive of the AcroQoL "Appearance" subscale score.…”

“…In fact, acromegalic patients with joint symptoms were found to have significantly lower QoL scores compared with patients without joint symptoms . Apart from physical impairment, previous research has shown that depressive symptoms and anxiety are also associated with reduced QoL in patients with acromegaly, suggesting that psychosocial impairment could be a target for improving QoL in acromegaly …”

“…Even when compared with patients with other pituitary tumours, patients with acromegaly demonstrate worse QoL scores. 25 Previous radiotherapy, 15,21,26 treatment with somatostatin analogues, 12 longer duration of active disease, 21 arthropathy, 21,24 biochemically active disease, 17,27,28 female gender 12 and symptoms of anxiety and depression 29 have been shown to negatively influence QoL in patients with acromegaly.…”

Neuropsychological functioning in acromegaly: towards identification of modifiable factors to improve long-term care after remission

“…The association is of particular interest because this implies that interventions aimed at improving anxiety and/or depression might improve cognitive performance, and consequently general well being. A recent study in patients with acromegaly even demonstrated superiority of psychopathology over biochemical control in predicting impaired quality of life [20].…”