Manoj Gedam
Department of Endocrinology, Guwahati Medical College, Assam, India
Dipti Sarma
Department of Endocrinology, Guwahati Medical College, Assam, India
Introduction: Acromegaly is chronic progressive disease with multisystem involvement characterised by an excess secretion of growth hormone and increased circulating insulin like growth factor 1 concentration.
Aims and Objectives: To assess surgical outcome of acromegaly patients at tertiary care institute using SF 36 quality of life questionnaire. SF-36 scores comprise 3 components: the physical component summary (PCS), the mental component summary (MCS) and role-social component summary (RCS).30 acromegaly patients admitted in Guwahati medical college were enrolled in study and followed up post operatively for surgical remission. All participants completed the SF-36 preoperatively, 1 year and 2 years postoperatively.
Material and Method: Out of 30 patients 6 patients had surgical remission post operatively on the basis of postoperative glucose suppressed GH Level done after 12 weeks. Preoperatively subscale scores (physical functioning, role physical, general health) which were below the set standards for the normal population show significant postoperative improvements along with mental health (MH) scores. Similarly, PCS, MCS and RCS scores changed significantly after surgery. We also compared the QOL of 6 patients whose peak GH level was < 0.4 µg/L during postoperative oral glucose tolerance testing with those patients whose nadir GH level was ≥ 0.4 µg/L. There was significant difference between partial and complete remission group in subscale score role physical, social function and mental health. Similarly, PCS and RCS score significantly different in partial and complete remission group than MCS score.
Conclusions: QOL is considerably reduced in patients with acromegaly compared to general population which improves significantly after surgical treatment. Patients achieving the new remission criteria had significant improvement in physical and social components than those who did not.
[1] Arita K, Kurisu K, Tominaga A, Eguchi K, Iida K, et al. (2003) Mortality in 154 surgically treated patients with acromegaly: a 10-year follow-up survey. Endocr J 50: 163-172.
[2] Beauregard C, Truong U, Hardy J, Serri O (2003) Longterm outcome and mortality after transsphenoidal adenomectomy for acromegaly. Clin Endocrinol (Oxf) 58: 86-91.
[3] Holdaway IM, Rajasoorya RC, Gamble GD (2004) Factors influencing mortality in acromegaly. J Clin Endocrinol Metab 89: 667-674.
[4] Fatti LM, Scacchi M, Pincelli AI, Lavezzi E, Cavagnini F: Prevalence and pathogenesis of sleep apnea and lung disease in acromegaly. Pituitary 2001, 4, 259–262.
[5] Orme SM, McNally RJ, Cartwright RA, Belchetz PE: Mortality and cancer incidence in acromegaly: a retrospective cohort study. J Clin Endocrin.
[6] Campbell PG, Kenning E, Andrews DW, Yadla S, Rosen M, et al. (2010) Outcomes after a purely endoscopic transsphenoidal resection of growth hormone-secreting pituitary adenomas. Neurosurg Focus 29: E5.
[7] Gondim JA, Almeida JP, de Albuquerque LA, Gomes E, Schops M, et al. (2010) Pure endoscopic transsphenoidal surgery for treatment of acromegaly: Results of 67 cases treated in a pituitary center. Neurosurg Focus 29: E7.
[8] Jane JA Jr, Starke RM, Elzoghby MA, Reames DL, Payne SC, et al. (2011) Endoscopic transsphenoidal surgery for acromegaly: remission using modern criteria, complications, and predictors of outcome. J Clin Endocrinol Metab 96: 2732-2740.
[9] Giustina A, Chanson P, Bronstein MD, Klibanski A, Lamberts S, et al. (2010) A consensus on criteria for cure of acromegaly. J Clin Endocrinol Metab 95: 3141-3148.
[10] Sinha R, van den Heuvel WJ, Arokiasamy P. Validity and reliability of mos short form health survey (sf-36) for use in India. Indian J Community Med 2013;38:22-6.
[11] Muniyandi M, Rajeswari R, Balasubramanian R, Nirupa C, Gopi PG, Jaggarajamma K, et al. Evaluation of post-treatment health-related quality of life (HRQoL) among tuberculosis patients. Int J Tuberc Lung Dis 2007;11:887-92.
[12] Sardella C, Lombardi M, Rossi G, Cosci C, Brogioni S, et al. (2010) Short- and long-term changes of quality of life in patients with acromegaly: results from a prospective study. J Endocrinol Invest 33: 20-25.
[13] Yoshida K, Fukuoka H, Matsumoto R, Bando H, Suda K, et al. (2015) The quality of life in acromegalic patients with biochemical remission by surgery alone is superior to that in those with pharmaceutical therapy without radiotherapy, using the newly developed Japanese version of the AcroQoL. Pituitary 18: 876-883.
[14] Biermasz NR, van Thiel SW, Pereira AM, Hoftijzer HC, van Hemert AM, et al. (2004) Decreased quality of life in patients with acromegaly despite long-term cure of growth hormone excess. J Clin Endocrinol Metab 89: 5369-5376.
[15] Fujio S, Arimura H, Hirano H, Habu M, Bohara M, Moinuddin FM, et al. Changes in quality of life in patients with acromegaly after surgical remission – a prospective study using SF-36 questionnaire. Endocr J (2016) 64(1):27–38. DOI: 10.1507/endocrj.EJ16-0182.
[16] Gilbert J, Ketchen M, Kane P, Mason T, Baister E, et al. (2003) The treatment of de novo acromegalic patients with octreotide-LAR: efficacy, tolerability and cardiovascular effects. Pituitary 6: 11-18.
[17] Matta MP, Couture E, Cazals L, Vezzosi D, Bennet A, et al. (2008) Impaired quality of life of patients with acromegaly: control of GH/IGF-I excess improves psychological subscale appearance. Eur J Endocrinol 158: 305-310.
[18] Dantas RA, Passos KE, Porto LB, Zakir JC, Reis MC, Naves LA. Physical activities in daily life and functional capacity compared to disease activity control in acromegalic patients: impact in self-reported quality of life. Arq Bras Endocrinol Metabol (2013) 57(7):550–7. DOI: 10.1590/S0004-27302013000700009.
[19] Kauppinen-Mäkelin R, Sane T, Sintonen H, Markkanen H, Välimäki MJ, et al. (2006) Quality of life in treated patients with acromegaly. J Clin Endocrinol Metab 91: 3891-3896.
[20] Espinosa-de-los-Monteros AL, Mercado M, Sosa E, Lizama O, Guinto G, et al. (2002) Changing patterns of insulin-like growth factor-I and glucose-suppressed growth hormone levels after pituitary surgery in patients with acromegaly. J Neurosurg 97: 287-292.
Aims and Scope