51
|
Andela CD, Tiemensma J, Kaptein AA, Scharloo M, Pereira AM, Kamminga NG, Biermasz NR. The partner's perspective of the impact of pituitary disease: Looking beyond the patient. J Health Psychol 2017; 24:1687-1697. [PMID: 28810427 PMCID: PMC6749171 DOI: 10.1177/1359105317695427] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
People with pituitary disease report impairments in quality of life. The aim of
this study was to elucidate the impact of the pituitary condition on the lives
of partners. Four focus groups of partners of people with pituitary disease
(Cushing’s disease, non-functioning adenoma, acromegaly, prolactinoma) were
conducted. Partners mentioned worries related to the pituitary disease and
negative beliefs about medication, coping challenges, relationship issues,
social issues and unmet needs regarding care. This study emphasizes the
importance of not only paying attention to psychosocial well-being of people
with pituitary disease but also to their partners.
Collapse
|
52
|
Abstract
In recent years, health-related quality of life (QoL) has been considered an important outcome for clinical management of acromegaly. Poor QoL has been described in acromegalic patients with active disease as well as after endocrine cure. It is known that acromegaly determines many physical problems and psychological dysfunctions that unavoidably impact on patients' QoL. Moreover, there is evidence that factors, such as radiotherapy or post-treatment GH deficiency also impair QoL in patients diagnosed with acromegaly. Thus, including the assessment of QoL in daily clinical practice has become fundamental to understand the consequences of acromegaly and the impact on the patients' daily life.
Collapse
Affiliation(s)
- Iris Crespo
- Endocrinology/Medicine Department, Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), C/Sant Antoni Maria Claret n.167, 08025, Barcelona, Spain
| | - Elena Valassi
- Endocrinology/Medicine Department, Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), C/Sant Antoni Maria Claret n.167, 08025, Barcelona, Spain
| | - Susan M Webb
- Endocrinology/Medicine Department, Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), C/Sant Antoni Maria Claret n.167, 08025, Barcelona, Spain.
| |
Collapse
|
53
|
Fujio S, Arimura H, Hirano H, Habu M, Bohara M, Moinuddin FM, Kinoshita Y, Arita K. Changes in quality of life in patients with acromegaly after surgical remission - A prospective study using SF-36 questionnaire. Endocr J 2017; 64:27-38. [PMID: 27681883 DOI: 10.1507/endocrj.ej16-0182] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Patients with acromegaly have a compromised quality of life (QOL). Modern surgical techniques have improved the surgical cure rate. However, there are no prospective studies reporting postoperative changes in QOL among patients cured solely by surgery. The aim of the present study was to determine the effect of surgery on QOL using the 36-item short form health survey (SF-36) questionnaire. SF-36 scores comprise 3 components: the physical component summary (PCS), the mental component summary (MCS) and role-social component summary (RCS). Included in this prospective cohort were 41 patients with acromegaly who underwent surgery alone and achieved postoperative normalization of insulin-like growth factor-1. All participants completed the SF-36 preoperatively and 1 year postoperatively. Preoperatively, RCS and 4 subscale scores (role physical, social functioning, role emotional, mental health) were below the set standards for the normal population. Postoperatively, the PCS and RCS scores did not change significantly, but the MCS score improved significantly (from 48.1 ± 11.3 to 51.7 ± 8.9, p=0.03). Further we compared the QOL of 26 patients whose nadir GH level was < 0.4 μg/L during postoperative oral glucose tolerance testing (complete remission group) with that of 15 patients whose nadir GH level was ≥ 0.4 μg/L (partial remission group). There were no significant differences between these groups in terms of PCS, MCS, RCS, or any subscale scores. In conclusion, surgical remission mostly improved the participants' mental condition. There was no difference in QOL between patients who achieved the new remission criteria and those who did not.
Collapse
Affiliation(s)
- Shingo Fujio
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan
| | | | | | | | | | | | | | | |
Collapse
|
54
|
Gheorghiu ML, Fleseriu M. STEREOTACTIC RADIATION THERAPY IN PITUITARY ADENOMAS, IS IT BETTER THAN CONVENTIONAL RADIATION THERAPY? ACTA ENDOCRINOLOGICA-BUCHAREST 2017; 13:476-490. [PMID: 31149219 DOI: 10.4183/aeb.2017.476] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Pituitary radiotherapy (RT) has undergone important progress in the last decades due to the development of new stereotactic techniques which provide more precise tumour targeting with less overall radiation received by the adjacent brain structures. Pituitary surgery is usually first-line therapy in most patients with nonfunctioning (NFPA) and functioning adenomas (except for prolactinomas and large growth hormone (GH) secreting adenomas), while RT is used as second or third-line therapy. The benefits of RT (tumour volume control and, in functional tumours, decreased hormonal secretion) are hampered by the long latency of the effect and the potential side effects. This review presents the updates in the efficacy and safety of the new stereotactic radiation techniques in patients with NFPA, GH-, ACTH- or PRL-secreting pituitary adenomas. Methods A systematic review was performed using PubMed and articles/abstracts and reviews detailing RT in pituitary adenomas from 2000 to 2017 were included. Results Stereotactic radiosurgery (SRS) and fractionated stereotactic RT (FSRT) provide high rates of tumour control i.e. stable or decrease in tumour size, in all types of pituitary adenomas (median 92 - 98%) at 5 years. Endocrinological remission is however significantly lower: 44-52% in acromegaly, 54-64% in Cushing's disease and around 30% in prolactinomas at 5 years. The rate of new hypopituitarism varies from 10% to 50% at 5 years in all tumour types and as expected increases with the duration of follow-up (FU). The risk for other radiation-induced complications is usually low (0-5% for new visual deficits, cranial nerves damage or brain radionecrosis and extremely low for secondary brain tumours), however longer FU is needed to determine rates of secondary tumours. Notably, in acromegaly, there may be a higher risk for stroke with FSRT. Conclusion Stereotactic radiotherapy can be an effective treatment option for patients with persistent or recurrent pituitary adenomas after unsuccessful surgery (especially if residual tumour is enlarging) and/or resistance or unavailability of medical therapy. Comparison with conventional radiation therapy (CRT) is rather difficult, due to the substantial heterogeneity of the studies. In order to evaluate the potential brain-sparing effect of the new stereotactic techniques, suggested by the current data, long-term studies evaluating secondary morbidity and mortality are needed.
Collapse
Affiliation(s)
- M L Gheorghiu
- "Carol Davila" University of Medicine and Pharmacy, "C.I. Parhon" National Institute of Endocrinology, Bucharest, Romania
| | - M Fleseriu
- Oregon Health & Science University, Departments of Medicine (Endocrinology) and Neurological Surgery, and Northwest Pituitary Center, Portland, USA
| |
Collapse
|
55
|
Geraedts VJ, Andela CD, Stalla GK, Pereira AM, van Furth WR, Sievers C, Biermasz NR. Predictors of Quality of Life in Acromegaly: No Consensus on Biochemical Parameters. Front Endocrinol (Lausanne) 2017; 8:40. [PMID: 28316591 PMCID: PMC5334635 DOI: 10.3389/fendo.2017.00040] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 02/16/2017] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Quality of life (QoL) in patients with acromegaly is reduced irrespective of disease state. The contributions of multifactorial determinants of QoL in several disease stages are presently not well known. OBJECTIVE To systematically review predictors of QoL in acromegalic patients. METHODS Main databases were systematically searched using predefined search terms for potentially relevant articles up to January 2017. Inclusion criteria included separate acromegaly cohort, non-hereditary acromegaly, QoL as study parameter with clearly described method of measurement and quantitative results, N ≥ 10 patients, article in English and adult patients only. Data extraction was performed by two independent reviewers; studies were included using the PRISMA flow diagram. RESULTS We identified 1,162 studies; 51 studies met the inclusion criteria: 31 cross-sectional observational studies [mean AcroQoL score 62.7 (range 46.6-87.0, n = 1,597)], 9 had a longitudinal component [mean baseline AcroQoL score 61.4 (range 54.3-69.0, n = 386)], and 15 were intervention studies [mean baseline AcroQoL score 58.6 (range 52.2-75.3, n = 521)]. Disease-activity reflected by biochemical control measures yielded mixed, and therefore inconclusive results with respect to their effect on QoL. Addition of pegvisomant to somatostatin analogs and start of lanreotide autogel resulted in improvement in QoL. Data from intervention studies on other treatment modalities were too limited to draw conclusions on the effects of these modalities on QoL. Interestingly, higher BMI and greater degree of depression showed consistently negative associations with QoL. Hypopituitarism was not significantly correlated with QoL in acromegaly. CONCLUSION At present, there is insufficient published data to support that biochemical control, or treatment of acromegaly in general, is associated with improved QoL. Studies with somatostatin receptor ligand treatment, i.e., particularly lanreotide autogel and pegvisomant have shown improved QoL, but consensus on the correlation with biochemical control is missing. Longitudinal studies investigating predictors in treatment-naive patients and their follow-up after therapeutic interventions are lacking but are urgently needed. Other factors, i.e., depression and obesity were identified from cross-sectional cohort studies as consistent factors associated with poor QoL. Perhaps treatment strategies of acromegaly patients should not only focus on normalizing biochemical markers but emphasize improvement of QoL by alternative interventions such as psychosocial or weight lowering interventions.
Collapse
Affiliation(s)
- Victor J. Geraedts
- Department of Clinical Neuroendocrinology, Max Planck Institut für Psychiatrie, Munich, Germany
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Netherlands
| | - Cornelie D. Andela
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Netherlands
| | - Günter K. Stalla
- Department of Clinical Neuroendocrinology, Max Planck Institut für Psychiatrie, Munich, Germany
| | - Alberto M. Pereira
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Netherlands
| | - Wouter R. van Furth
- Department of Medicine, Division of Neurosurgery, Leiden University Medical Center, Leiden, Netherlands
| | - Caroline Sievers
- Department of Clinical Neuroendocrinology, Max Planck Institut für Psychiatrie, Munich, Germany
| | - Nienke R. Biermasz
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Netherlands
- *Correspondence: Nienke R. Biermasz,
| |
Collapse
|
56
|
Öberg K, Lamberts SWJ. Somatostatin analogues in acromegaly and gastroenteropancreatic neuroendocrine tumours: past, present and future. Endocr Relat Cancer 2016; 23:R551-R566. [PMID: 27697899 DOI: 10.1530/erc-16-0151] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 10/03/2016] [Indexed: 11/08/2022]
Abstract
Acromegaly is a hormonal disorder that arises when the pituitary gland secretes excess growth hormone (GH), which in turn stimulates a concomitant increase in serum insulin-like growth factor 1 (IGF-1) levels. Gastroenteropancreatic neuroendocrine tumours (GEP-NET) constitute a heterogeneous group of tumours that can secrete serotonin and a variety of peptide hormones that may cause characteristic symptoms known as carcinoid syndrome or other symptoms and hormonal hypersecretion syndromes depending on the tumour's site of origin. Current medical therapy for the treatment of acromegaly and GEP-NET involves the administration of somatostatin analogues that effectively suppress excess hormone secretion. After its discovery in 1979, octreotide became the first synthetic biologically stable somatostatin analogue with a short-acting formulation of octreotide introduced into clinical practice in the late 1980s. Lanreotide, another somatostatin analogue, became available in the mid-1990s initially as a prolonged-release formulation administered every 10 or 14 days. Long-acting release formulations of both octreotide (Sandostatin LAR and Novartis) and lanreotide (Somatuline Autogel, Ipsen), based on microparticle and nanoparticle drug-delivery technologies, respectively, were later developed, which allowed for once-monthly administration and improved convenience. First-generation somatostatin analogues remain one of the cornerstones of medical therapy in the management of pituitary and GEP-NET hormone hypersecretion, with octreotide having the longest established efficacy and safety profile of the somatostatin analogue class. More recently, pasireotide (Signifor), a next-generation multireceptor-targeted somatostatin analogue, has emerged as an alternative therapeutic option for the treatment of acromegaly. This review summarizes the development and clinical success of somatostatin analogues.
Collapse
|
57
|
Walchan EM, Guimarães FS, Soares MS, Kasuki L, Gadelha MR, Lopes AJ. Parameters of knee isokinetic dynamometry in individuals with acromegaly: Association with growth hormone levels and general fatigue. ISOKINET EXERC SCI 2016. [DOI: 10.3233/ies-160635] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Evelyn M. Walchan
- Programa de Pós-graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta, Rio de Janeiro, Brazil
| | - Fernando S. Guimarães
- Programa de Pós-graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta, Rio de Janeiro, Brazil
- Departamento de Fisioterapia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mauricio S. Soares
- Programa de Pós-graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta, Rio de Janeiro, Brazil
- Centro de Educação Física Almirante Adalberto Nunes, Rio de Janeiro, Brazil
| | - Leandro Kasuki
- Departamento de Endocrinologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
| | - Monica R. Gadelha
- Departamento de Endocrinologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
| | - Agnaldo J. Lopes
- Programa de Pós-graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta, Rio de Janeiro, Brazil
- Programa de Pós-graduação em Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
58
|
Wolf A, Coros A, Bierer J, Goncalves S, Cooper P, Van Uum S, Lee DH, Proulx A, Nicolle D, Fraser JA, Rotenberg BW, Duggal N. Quantitative evaluation of vision-related and health-related quality of life after endoscopic transsphenoidal surgery for pituitary adenoma. J Neurosurg 2016; 127:409-416. [PMID: 27715435 DOI: 10.3171/2016.7.jns16200] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Endoscopic resection of pituitary adenomas has been reported to improve vision function in up to 80%-90% of patients with visual impairment due to these adenomas. It is unclear how these reported rates translate into improvement in visual outcomes and general health as perceived by the patients. The authors evaluated self-assessed health-related quality of life (HR-QOL) and vision-related QOL (VR-QOL) in patients before and after endoscopic resection of pituitary adenomas. METHODS The authors prospectively collected data from 50 patients who underwent endoscopic resection of pituitary adenomas. This cohort included 32 patients (64%) with visual impairment preoperatively. Twenty-seven patients (54%) had pituitary dysfunction, including 17 (34%) with hormone-producing tumors. Patients completed the National Eye Institute Visual Functioning Questionnaire and the 36-Item Short Form Health Survey preoperatively and 6 weeks and 6 months after surgery. RESULTS Patients with preoperative visual impairment reported a significant impact of this condition on VR-QOL preoperatively, including general vision, near activities, and peripheral vision; they also noted vision-specific impacts on mental health, role difficulties, dependency, and driving. After endoscopic resection of adenomas, patients reported improvement across all these categories 6 weeks postoperatively, and this improvement was maintained by 6 months postoperatively. Patients with preoperative pituitary dysfunction, including hormone-producing tumors, perceived their general health and physical function as poorer, with some of these patients reporting improvement in perceived general health after the endoscopic surgery. All patients noted that their ability to work or perform activities of daily living was transiently reduced 6 weeks postoperatively, followed by significant improvement by 6 months after the surgery. CONCLUSIONS Both VR-QOL and patient's perceptions of their ability to do work and perform other daily activities as a result of their physical health significantly improved by 6 months after endoscopic resection of pituitary adenoma. The use of multidimensional QOL questionnaires provides a precise assessment of perceived outcomes after endoscopic surgery.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Donald H Lee
- Department of Medical Imaging, London Health Sciences Centre; and
| | - Alain Proulx
- Department of Ophthalmology, Ivey Eye Institute, and
| | | | | | - Brian W Rotenberg
- Department of Otolaryngology-Head & Neck Surgery, St. Joseph's Hospital, London, Ontario, Canada
| | | |
Collapse
|
59
|
Pereira AM. Long-term effects of treatment of pituitary adenomas. HANDBOOK OF CLINICAL NEUROLOGY 2016; 124:361-71. [PMID: 25248599 DOI: 10.1016/b978-0-444-59602-4.00024-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Pituitary adenomas can be treated effectively in the vast majority of cases. After successful treatment for pituitary disease, many patients still report reduced quality of life in the presence of persistent morbidity and (slightly) increased mortality. At present, there is an increasing awareness that in many cases long-term remission of functioning or nonfunctioning adenomas does not equal cure. The causes are most probably multifactorial. Hypopituitarism, intrinsic imperfections of surgical or endocrine replacement therapy, but also persistent effects of treatment and of previous hormone excess on the central nervous system all affect long-term morbidity, general well-being, and mortality. This implies that treatment goals for patients with pituitary adenomas will shift from long-term cure to long-term care. Further research is therefore needed to get more insight into each of these factors of influence, such as the extent of reversibility of hormone excess syndromes on cardiovascular risk and behavior. The fact that coping strategies, despite long-term remission, are altered and illness perceptions are affected strongly suggests that long-term care should incorporate self-management interventions that might help to improve quality of life for patients.
Collapse
Affiliation(s)
- Alberto M Pereira
- Department of Endocrinology and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The Netherlands.
| |
Collapse
|
60
|
Abstract
BACKGROUND Acromegaly has important effects on quality of life (QOL). This is the first study to measure QOL in acromegalic patients after endoscopic transsphenoidal surgery (ETSS). METHODS We prospectively collected the RAND-36, Center for Epidemiologic Studies Depression (CES-D), and Pituitary QOL validated questionnaires and patients' demographics, clinical presentation, endocrine laboratory results, radiological studies, development of complications and remission rates from 20 consecutive acromegalic patients who had undergone endoscopic transphenoidal surgery. RESULTS The eleven females and nine males had an average age of 42 years; 90 percent had macroadenomas and 70% had cavernous sinus invasion on their preoperative imaging. Ninety percent had improved symptoms post-operatively and 80% stated that treatment improved their QOL. Biochemically, 35% were cured, 35% had discordant results and 30% were not cured, while pan-hypopituitarism occurred in 4 patients. Physical health subscales and pituitary-related symptoms were similar to norms. "Social," "emotional health," and "energy levels" were significantly lower than norms. Seventy percent stated that their relationship with their physician "very much so" affected their quality of life. Pan hypopituitarism and adjuvant therapy were the most significant predictors of lower QOL subscale scores. CONCLUSION Transsphenoidal surgery improves QOL in acromegaly. Attempts to achieve a cure, avoidance of surgically induced pan-hypotpituitarism and adjuvant therapy, will improve quality of life. Our study demonstrates the important role of the patient-physician relationship to QOL and the need to measure QOL in addition to the traditional measures of outcome.
Collapse
|
61
|
Follin C, Karlsson S. Attitudes and preferences in patients with acromegaly on long-term treatment with somatostatin analogues. Endocr Connect 2016; 5:167-73. [PMID: 27458240 PMCID: PMC5308196 DOI: 10.1530/ec-16-0038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 07/21/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Patients with acromegaly can be treated with surgery, medical therapy and/or radiation therapy. For the patients not being cured with surgery, treatment with somatostatin analogues (SSAs) is the primary therapy. SSA can be taken by self- or partner-administered injections in addition to being given by a nurse at a clinic. The aim was to assess if patients with acromegaly prefer self-injections and to investigate their attitudes towards long-term medical therapy. METHOD All patients in the southern medical region of Sweden with a diagnosis of acromegaly and treated with SSA were eligible for the study (n = 24). The study is based on a questionnaire asking about the patients' attitudes and preferences for injections with SSA, including their attitudes towards self-injection with SSA. RESULTS The patients' (23 included) median age was 68.5 years and the patients had been treated with SSA for 13 (1-38) years. One patient was currently self-injecting. All of the other patients were receiving injections from a nurse at a clinic. Three patients preferred self-injections, one preferred partner injections and 19 patients did not prefer self- or partner injections. The most frequent arguments to not preferring self-injections were 'feeling more secure with an educated nurse' and 'preferring regular contact with a specialised nurse'. CONCLUSION Patients with acromegaly prefer regular contact with the endocrine team to the independence offered by self-injections. These findings might mirror the patients' desires for continuity and safety. We need to address patients' concerns regarding injections with SSA and support them in their choices.
Collapse
Affiliation(s)
- Cecilia Follin
- Department of EndocrinologySkåne University Hospital, Lund, Sweden
| | - Sven Karlsson
- Department of EndocrinologySkåne University Hospital, Lund, Sweden
| |
Collapse
|
62
|
Andela CD, Scharloo M, Ramondt S, Tiemensma J, Husson O, Llahana S, Pereira AM, Kaptein AA, Kamminga NGA, Biermasz NR. The development and validation of the Leiden Bother and Needs Questionnaire for patients with pituitary disease: the LBNQ-Pituitary. Pituitary 2016; 19:293-302. [PMID: 26809957 PMCID: PMC4858557 DOI: 10.1007/s11102-016-0707-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Patients report persisting impairment in quality of life (QoL) after treatment for pituitary disease. At present, there is no questionnaire to assess (a) whether patients with pituitary disease are bothered by these consequences, and (b) their needs for support. OBJECTIVE To develop and validate a disease-specific questionnaire for patients with pituitary disease which incorporates patient perceived bother related to the consequences of the disease, and their needs for support. METHODS Items for the Leiden Bother and Needs Questionnaire for patients with pituitary disease (LBNQ-Pituitary) were formulated based on results of a recent focus group study (n = 49 items). 337 patients completed the LBNQ-Pituitary and six validated QoL questionnaires (EuroQoL-5D, SF-36, MFI-20, HADS, AcroQol, CushingQoL). Construct validity was examined by exploratory factor analysis. Reliabilities of the subscales were calculated with Cronbach's alphas, and concurrent validity was assessed by calculating Spearman's correlations between the LBNQ-Pituitary and the other measures. RESULTS Factor analyses produced five subscales (i.e., mood problems, negative illness perceptions, issues in sexual functioning, physical and cognitive complaints, issues in social functioning) containing a total of 26 items. All factors were found to be reliable (Cronbach's alphas all ≥.765), and the correlations between the dimensions of the LBNQ-Pituitary and other questionnaires (all P ≤ .0001) demonstrated convergent validity. CONCLUSIONS The LBNQ-Pituitary can be used to assess the degree to which patients are bothered by the consequences of the pituitary disease, as well as their needs for support. It could also facilitate an efficient assessment of patients' needs for support in clinical practice. We postulate that paying attention to needs for support will lead to optimal patient care (e.g., improvement in psychosocial care), and positively affect QoL.
Collapse
Affiliation(s)
- Cornelie D Andela
- Department of Medicine, Division of Endocrinology and Center for Endocrine Tumors, C7-Q, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Margreet Scharloo
- Medical Psychology, Leiden University Medical Center, Leiden, The Netherlands
| | - Steven Ramondt
- Psychological Science, University of California, Merced, CA, USA
| | - Jitske Tiemensma
- Psychological Science, University of California, Merced, CA, USA
| | - Olga Husson
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sofia Llahana
- Center for Behavioural Medicine, University College London, London, UK
| | - Alberto M Pereira
- Department of Medicine, Division of Endocrinology and Center for Endocrine Tumors, C7-Q, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Ad A Kaptein
- Medical Psychology, Leiden University Medical Center, Leiden, The Netherlands
| | - Noëlle G A Kamminga
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nienke R Biermasz
- Department of Medicine, Division of Endocrinology and Center for Endocrine Tumors, C7-Q, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| |
Collapse
|
63
|
Bima C, Chiloiro S, Mormando M, Piacentini S, Bracaccia E, Giampietro A, Tartaglione L, Bianchi A, De Marinis L. Understanding the effect of acromegaly on the human skeleton. Expert Rev Endocrinol Metab 2016; 11:263-270. [PMID: 30058934 DOI: 10.1080/17446651.2016.1179108] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Acromegaly, caused in most cases by Growth Hormone (GH)-secreting pituitary adenomas, is characterized by increased skeletal growth and enlargement of the soft tissue, because GH and its effector Insulin-like Growth factor-1 are important regulators of bone homeostasis and have a central role in the longitudinal bone growth and maintenance of bone mass. Areas covered: Despite the anabolic effect of these hormones is well known, as a result of the stimulation of bone turnover and especially of bone formation, many acromegalic patients are suffering from a form of secondary osteoporosis with increased risk of fractures. Expert commentary: In this review, we summarize the pathophysiology, diagnosis, clinical picture, disease course and management of skeletal complications of acromegaly, focusing in particular on secondary osteoporosis and fracture risk in acromegaly.
Collapse
Affiliation(s)
- C Bima
- a Pituitary Unit, Department of Endocrinology , Catholic University of "Sacred Heart", School of Medicine , Rome , Italy
| | - S Chiloiro
- a Pituitary Unit, Department of Endocrinology , Catholic University of "Sacred Heart", School of Medicine , Rome , Italy
| | - M Mormando
- a Pituitary Unit, Department of Endocrinology , Catholic University of "Sacred Heart", School of Medicine , Rome , Italy
| | - S Piacentini
- a Pituitary Unit, Department of Endocrinology , Catholic University of "Sacred Heart", School of Medicine , Rome , Italy
| | - E Bracaccia
- a Pituitary Unit, Department of Endocrinology , Catholic University of "Sacred Heart", School of Medicine , Rome , Italy
| | - A Giampietro
- a Pituitary Unit, Department of Endocrinology , Catholic University of "Sacred Heart", School of Medicine , Rome , Italy
| | - L Tartaglione
- a Pituitary Unit, Department of Endocrinology , Catholic University of "Sacred Heart", School of Medicine , Rome , Italy
| | - A Bianchi
- a Pituitary Unit, Department of Endocrinology , Catholic University of "Sacred Heart", School of Medicine , Rome , Italy
| | - L De Marinis
- a Pituitary Unit, Department of Endocrinology , Catholic University of "Sacred Heart", School of Medicine , Rome , Italy
| |
Collapse
|
64
|
Karppinen A, Ritvonen E, Roine R, Sintonen H, Vehkavaara S, Kivipelto L, Grossman AB, Niemelä M, Schalin-Jäntti C. Health-related quality of life in patients treated for nonfunctioning pituitary adenomas during the years 2000-2010. Clin Endocrinol (Oxf) 2016; 84:532-9. [PMID: 26493182 DOI: 10.1111/cen.12967] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 09/23/2015] [Accepted: 10/19/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The published data on health-related quality of life (HRQoL) after treatment of nonfunctioning pituitary adenomas (NFPAs) are conflicting. We evaluated HRQoL in a recent series of patients who had surgery for an NFPA. DESIGN Cross-sectional study including a large control population. PATIENTS AND MEASUREMENTS A HRQoL questionnaire (15D) was sent to all patients (n = 161) having undergone transsphenoidal surgery for NFPA in the years 2000-2010 at the Helsinki University Hospital. The 15D score and dimension scores of the study population (n = 137) were compared with those of a large (n = 4967) gender- and age-standardized control population. Possible independent predictors of HRQoL in the patients were estimated with multivariate regression analysis. RESULTS Postoperatively, 57% of the patients had normal visual function. After a mean follow-up of 7·4 ± 3·2 years (mean ± SD), 62% suffered from hypopituitarism. Overall, HRQoL was near-normal in patients compared to controls (15D scores 0·885 ± 0·114 vs 0·903 ± 0·093, respectively, P = 0·07). On single dimensions, patients had impaired vision and sexual activity (both P < 0·0005), more depression and distress (both P < 0·005) and less discomfort and symptoms (P < 0·05). Age, body mass index, diabetes, depression and reoperation were independent predictors of impaired HRQoL (all P < 0·05). Thyroxine substitution was associated with impaired and hydrocortisone and testosterone substitution (males only) with better HRQoL (all P < 0·05). CONCLUSIONS This recent series of NFPA patients demonstrates that overall HRQoL is near-normal after medium term follow-up; the most impaired dimensions were in vision and sexual activity. Comorbidities are strong predictors of impaired HRQoL.
Collapse
Affiliation(s)
- Atte Karppinen
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Elina Ritvonen
- Endocrinology, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Risto Roine
- Group Administration, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Satu Vehkavaara
- Endocrinology, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Leena Kivipelto
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ashley B Grossman
- Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology & Metabolism, Churchill Hospital, University of Oxford, UK
| | - Mika Niemelä
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Camilla Schalin-Jäntti
- Endocrinology, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
65
|
Neggers SJCMM, Muhammad A, van der Lely AJ. Pegvisomant Treatment in Acromegaly. Neuroendocrinology 2016; 103:59-65. [PMID: 25792221 DOI: 10.1159/000381644] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 03/04/2015] [Indexed: 11/19/2022]
Abstract
Historically, medical treatment of acromegaly has mainly been used as an adjuvant therapy after surgery. In the last decades, an increased range of medical therapy options has been available. Somatostatin analogues have become the cornerstones of medical treatment in acromegaly and are even seen as a primary treatment in a selected group of acromegaly patients. The most recent medical treatment available for acromegaly patients is pegvisomant, a growth hormone receptor antagonist. To date, it is the most effective medical treatment, but it is costly. Pegvisomant is used as monotherapy and combined with somatostatin analogues. In this article, we review clinical studies and cohorts that have documented the efficacy of pegvisomant monotherapy and combined therapy and give a concise overview of associated side effects.
Collapse
Affiliation(s)
- Sebastian J C M M Neggers
- Section of Endocrinology, Department of Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | | |
Collapse
|
66
|
Abstract
Available disease-specific questionnaires like the Acromegaly Quality of Life questionnaire have confirmed that quality of life (QoL) is impaired in acromegaly, especially in active disease. Successful therapy improves QoL, but it may not normalize completely even after endocrine cure; furthermore, there is not always a correlation between growth hormone (GH) and insulin-like growth factor 1 and subjective health perception of QoL. Appearance is the dimension most affected and has the highest impact on the patient's QoL. Worse QoL is associated with the presence of musculoskeletal pain, headache (if only medical therapy, not surgery, has been provided), having required treatment with radiotherapy, being older, of female gender, with a longer disease duration, coexisting diabetes mellitus, a higher BMI or becoming GH deficient after treatment for acromegaly.
Collapse
Affiliation(s)
- Susan M Webb
- Endocrinology/Medicine Departments, Hospital Sant Pau, Centro de Investigacix00F3;n Biomx00E9;dica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, IIB-Sant Pau, Barcelona, Spain
| | | |
Collapse
|
67
|
Claessen KMJA, Mazziotti G, Biermasz NR, Giustina A. Bone and Joint Disorders in Acromegaly. Neuroendocrinology 2016; 103:86-95. [PMID: 25633971 DOI: 10.1159/000375450] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 01/22/2015] [Indexed: 11/19/2022]
Abstract
Acromegaly is a chronic, progressive disease caused by a growth hormone (GH)-producing pituitary adenoma, resulting in elevated GH and insulin-like growth factor 1 concentrations. Following appropriate therapy (surgery, radiotherapy and/or medical treatment), many systemic GH-induced comorbid conditions improve considerably. Unfortunately, despite biochemical control, acromegaly patients suffer from a high prevalence of late manifestations of transient GH excess, significantly impairing their quality of life. In this overview article, we summarize the pathophysiology, diagnosis, clinical picture, disease course and management of skeletal complications of acromegaly, focusing on vertebral fractures and arthropathy.
Collapse
Affiliation(s)
- Kim M J A Claessen
- Department of Endocrinology and Metabolism, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | | |
Collapse
|
68
|
Pereira AM. Neuropsychological functioning in acromegaly: towards identification of modifiable factors to improve long-term care after remission. Endocrine 2015; 50:523-5. [PMID: 26349939 DOI: 10.1007/s12020-015-0736-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 08/25/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Alberto M Pereira
- Division of Endocrinology, Department of Medicine, and Center for Endocrine Tumors Leiden, Leiden University Medical Center, Leiden, The Netherlands.
| |
Collapse
|
69
|
Sievers C, Baur DM, Schwanke A, Buchfelder M, Droste M, Mann K, Stalla GK. Prediction of therapy response in acromegalic patients under pegvisomant therapy within the German ACROSTUDY cohort. Pituitary 2015. [PMID: 26224528 DOI: 10.1007/s11102-015-0673-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE This study aimed at investigating predicting factors for therapy response under growth hormone receptor antagonist therapy with a focus on subjective and patient-oriented measures. METHODS Observational, multicenter nested-cohort study including 271 selected patients with the diagnosis of acromegaly and a minimum of one-year follow-up period within the German ACROSTUDY cohort (total cohort: n = 514). Outcome measures were the change of the biomarker IGF-1 (IGF-1 change and IGF-1 normalisation) between baseline and after 1 year of pegvisomant therapy (12 ± 6 months). Main predictors were patient-assessed subjective measures according to the Patient-Assessed Acromegaly Symptom Questionnaire (PASQ) in conjugation with age, gender, BMI, max. dosage of pegvisomant at follow-up and IGF-1 before the start of pegvisomant therapy. RESULTS The mean age of the study population was 51.2 (13.9) years and the mean BMI was 29.5 (5.1) kg/m(2). In adjusted analyses, none of the individual perceived health (PASQ) scores, but age, BMI and IGF-1 at baseline were predictive for an IGF-1 decrease after 1 year of pegvisomant therapy and BMI and IGF-1, but equally none of the PASQ items, were predicting IGF-1 normalisation. CONCLUSIONS Age, BMI and baseline IGF-1 but not subjective perceived health measures predict therapy response under second line medical therapy with pegvisomant.
Collapse
Affiliation(s)
- Caroline Sievers
- Clinical Neuroendocrinology, Clinical Research Department, Max Planck Institute of Psychiatry, Kraepelinstr. 2-10, 80804, Munich, Germany.
| | - Dorothee M Baur
- II Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Ismaningerstrasse 22, 81675, Munich, Germany
| | | | - Michael Buchfelder
- Department of Neurosurgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | | | - Klaus Mann
- Department of Endocrinology and Metabolism, University of Duisburg-Essen and Endokrinologiezentrum, Alter Hof, Munich, Germany
| | - Günter K Stalla
- Clinical Neuroendocrinology, Clinical Research Department, Max Planck Institute of Psychiatry, Kraepelinstr. 2-10, 80804, Munich, Germany
| |
Collapse
|
70
|
Yoshida K, Fukuoka H, Matsumoto R, Bando H, Suda K, Nishizawa H, Iguchi G, Ogawa W, Webb SM, Takahashi Y. 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 2015; 18:876-83. [PMID: 26123761 DOI: 10.1007/s11102-015-0665-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To develop a Japanese version of the acromegaly quality of life (QoL) questionnaire (AcroQoL) and investigate the factors associated with impaired QoL in patients with acromegaly. METHODS We developed a Japanese version of the AcroQoL by a forward-backward method and evaluated QoL in 38 patients with acromegaly who had been followed up at an outpatient clinic at Kobe University Hospital. Its reliability was examined with Cronbach's alpha and item-total correlations. Second examination was performed for concurrent validity by assessment of correlations with the Short Form-36 (SF-36) and longitudinal analysis of the AcroQoL in 25 patients. RESULTS Cronbach's alpha and item-total correlations showed a range of 0.76-0.93 and 0.20-0.84, respectively, and significant correlations were found between the AcroQoL and the SF-36. Younger age and a history of radiotherapy were associated with worse total score by the multivariate linear regression analysis (p = 0.020 and p = 0.042, respectively). Intriguingly, in the biochemically-controlled group after the exclusion of patients who received radiotherapy, patients who underwent surgery alone exhibited a higher psychological (75.0 vs. 65.7 %, p = 0.036) and appearance (64.3 vs. 53.6 %, p = 0.036) score than those who are treating with pharmaceutical therapy. CONCLUSIONS The reliability of the Japanese version of the AcroQoL was satisfactory. Younger age and a history of radiotherapy were associated with lower QoL in patients with acromegaly. In biochemically-controlled acromegaly, patients who underwent surgery alone exhibited better QoL than those under pharmaceutical therapy.
Collapse
Affiliation(s)
- Kenichi Yoshida
- Division of Diabetes and Endocrinology, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
| | - Hidenori Fukuoka
- Division of Diabetes and Endocrinology, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Ryusaku Matsumoto
- Division of Diabetes and Endocrinology, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
| | - Hironori Bando
- Division of Diabetes and Endocrinology, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
| | - Kentaro Suda
- Division of Diabetes and Endocrinology, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Hitoshi Nishizawa
- Division of Diabetes and Endocrinology, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Genzo Iguchi
- Division of Diabetes and Endocrinology, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Wataru Ogawa
- Division of Diabetes and Endocrinology, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
| | - Susan M Webb
- Endocrinology/Medicine Departments, Center for Biomedical Network Research on Rare Diseases (CIBERER Unit 747), ISCIII, Sant Pau Biomedical Research Institute, Hospital de Sant Pau Universitat Autònoma de Barcelona, C/Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
| | - Yutaka Takahashi
- Division of Diabetes and Endocrinology, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
| |
Collapse
|
71
|
Abstract
PURPOSE The Acromegaly Consensus Group recently released updated guidelines for medical management of acromegaly patients. We subjected these guidelines to a cost analysis. METHODS We conducted a cost analysis of the recommendations based on published efficacy rates as well as publicly available cost data. The results were compared to findings from a previously reported comparative effectiveness analysis of acromegaly treatments. Using decision tree software, two models were created based on the Acromegaly Consensus Group's recommendations and the comparative effectiveness analysis. The decision tree for the Consensus Group's recommendations was subjected to multi-way tornado analysis to identify variables that most impacted the value analysis of the decision tree. RESULTS The value analysis confirmed the Consensus Group's recommendations of somatostatin analogs as first line therapy for medical management. Our model also demonstrated significant value in using dopamine agonist agents as upfront therapy as well. Sensitivity analysis identified the cost of somatostatin analogs and growth hormone receptor antagonists as having the most significant impact on the cost effectiveness of medical therapies. CONCLUSION Our analysis confirmed the value of surgery as first-line therapy for patients with surgically accessible lesions. Surgery provides the greatest value for management of patients with acromegaly. However, in accordance with the Acromegaly Consensus Group's recent recommendations, somatostatin analogs provide the greatest value and should be used as first-line therapy for patients who cannot be managed surgically. At present, the substantial cost is the most significant negative factor in the value of medical therapies for acromegaly.
Collapse
Affiliation(s)
- Kristopher T Kimmell
- The Department of Neurosurgery, University of Rochester Medical Center, 601 Elmwood Avenue, Box 670, Rochester, NY, 14642, USA,
| | | | | |
Collapse
|
72
|
Andela CD, Scharloo M, Pereira AM, Kaptein AA, Biermasz NR. Quality of life (QoL) impairments in patients with a pituitary adenoma: a systematic review of QoL studies. Pituitary 2015; 18:752-76. [PMID: 25605584 DOI: 10.1007/s11102-015-0636-7] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Pituitary adenomas give rise to physical and psychological symptoms, which may persist after biochemical cure. Growing attention has been paid to quality of life (QoL) in these patients. We aimed to systematically analyze QoL assessment methods and QoL outcome in these patients. METHODS We conducted a systematic literature search up to January 2014 in PubMed, Web of Knowledge, PsycInfo and EMBASE. RESULTS 102 papers assessing QoL in patients with a pituitary adenoma were included. In clinical (original) studies in which QoL was the primary outcome parameter (n = 54), 19 studies combined a generic questionnaire with a disease-specific questionnaire. QoL was found to be impaired in patients with active disease relative to controls, and generally improved during biochemical cure. However, no normalization occurred, with patients with remitted Cushing's disease demonstrating the smallest improvement. Somatic factors (e.g., hypopituitarism, sleep characteristics), psychological factors (illness perceptions) and health care environment (rural vs. urban) were identified as influencing factors. Intervention studies (predominantly evaluating medical interventions) have been found to improve QoL. CONCLUSIONS The growing number of studies assessing QoL generally described the negative impact of pituitary adenomas. QoL research in this patient group could be further elaborated by the development of disease-specific questionnaires for prolactinoma and non-functioning adenoma, consequent use of generic and disease-specific questionnaires and using a long-term (longitudinal) follow-up. Surgical and pharmacological interventions improve but not normalize QoL. We postulate that there might be margin for further improvement of QoL, for instance by using psychosocial interventions, in addition to optimal medical treatment.
Collapse
Affiliation(s)
- Cornelie D Andela
- Division of Endocrinology and Center for Endocrine Tumors Leiden, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands,
| | | | | | | | | |
Collapse
|
73
|
Andela CD, Biermasz NR, Kaptein AA, Pereira AM, Tiemensma J. More concerns and stronger beliefs about the necessity of medication in patients with acromegaly are associated with negative illness perceptions and impairment in quality of life. Growth Horm IGF Res 2015; 25:219-226. [PMID: 26164770 DOI: 10.1016/j.ghir.2015.06.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 06/10/2015] [Accepted: 06/24/2015] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Patients with acromegaly can be treated with surgery, radiotherapy and/or medical treatment. In general, patients' beliefs about medication are associated with illness perceptions, a contributory factor of Quality of Life (QoL). At present, there are no quantitative studies on medication beliefs in patients with acromegaly. Here, we aimed to examine possible associations between medication beliefs, illness perceptions, and QoL. Furthermore we aimed to explore whether illness perceptions of patients with remission of acromegaly receiving medical treatment differ from patients without medical treatment. DESIGN Cross-sectional evaluation of 73 patients with remission of acromegaly (n = 28 patients with medication, n = 45 without medication). The Beliefs about Medicines Questionnaire (BMQ), Illness Perception Questionnaire-Revised (IPQ-R), EuroQoL-5D, and AcroQoL were used for the assessment. RESULTS Stronger beliefs about the necessity of medical treatment and stronger concerns about the adverse effects were associated with attributing more symptoms to acromegaly, perceiving more negative consequences, and having a stronger belief in a cyclical timeline (BMQ, all P < 0.05). Stronger beliefs about the necessity of medical treatment were associated with a worse disease-specific QoL (BMQ, P < 0.01). Patients with medical treatment perceived a more chronic timeline of their disease, compared to patients without medical treatment (IPQ-R, P = 0.002). CONCLUSION Negative medication beliefs were related to more negative illness perceptions and worse disease-specific QoL. Patients receiving medical treatment for acromegaly tend to perceive a more chronic timeline of their disease, compared to patients with remission without medical treatment. These psychological factors need to be taken into account when treating patients and developing a psychosocial education program aiming to improve QoL.
Collapse
Affiliation(s)
- Cornelie D Andela
- Department of Medicine, Division of Endocrinology and Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, The Netherlands
| | - Nienke R Biermasz
- Department of Medicine, Division of Endocrinology and Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, The Netherlands
| | - Adrian A Kaptein
- Department of Medical Psychology, Leiden University Medical Center, Leiden, The Netherlands
| | - Alberto M Pereira
- Department of Medicine, Division of Endocrinology and Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, The Netherlands
| | - Jitske Tiemensma
- Department of Medicine, Division of Endocrinology and Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, The Netherlands; Psychological Science, University of California, Merced, CA, United States.
| |
Collapse
|
74
|
Vandeva S, Yaneva M, Natchev E, Elenkova A, Kalinov K, Zacharieva S. Disease control and treatment modalities have impact on quality of life in acromegaly evaluated by Acromegaly Quality of Life (AcroQoL) Questionnaire. Endocrine 2015; 49:774-82. [PMID: 25561370 DOI: 10.1007/s12020-014-0521-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 12/21/2014] [Indexed: 10/24/2022]
Abstract
Various factors influence quality of life (QoL) in acromegaly. Whether disease control and treatment approach are related to QoL is still a matter of debate. The aim of the present study was to evaluate QoL in patients with acromegaly using the disease-specific Acromegaly Quality of Life Questionnaire in respect to disease activity, treatment modalities, and other factors. We studied 212 patients with acromegaly in a cross-sectional manner over a 6-year period in a single tertiary center. As a second step, seventy of the patients who were with active disease at baseline were followed up prospectively and 45 of them were in remission at re-evaluation. In regard to the cross-sectional group, active acromegaly independently predicted worse appearance scores. Prior radiotherapy and older age were independent negative predictors of all scales. Female gender negatively predicted all scales except the appearance domain. Longer duration of remission predicted worse personal relations scores in biochemically controlled patients. The use of somatostatin analog (SSA) was associated with worse personal relations scores, while higher IGF-1 index predicted worse appearance scores in patients with active acromegaly. In the prospective group, achievement of remission independently predicted improvement of the total scale. Lower corresponding baseline scores predicted improvement of the total, physical, and appearance scales, while the absence of hypopituitarism independently predicted improvement of the appearance scale. The use of SSA was associated with improvement of the total and appearance scores. In conclusion, QoL is a multifactorial issue that needs an individualized approach for detection and management.
Collapse
Affiliation(s)
- Silvia Vandeva
- Clinical Center of Endocrinology and Gerontology, Medical University - Sofia, Zdrave 2 str., 1431, Sofia, Bulgaria,
| | | | | | | | | | | |
Collapse
|
75
|
Hatipoglu E, Topsakal N, Erkut Atilgan O, Camliguney AF, Ikitimur B, Ugurlu S, Niyazoglu M, Cotuk HB, Kadioglu P. Physical and cardiovascular performance in cases with acromegaly after regular short-term exercise. Clin Endocrinol (Oxf) 2015; 83:91-7. [PMID: 25523748 DOI: 10.1111/cen.12708] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 12/05/2014] [Accepted: 12/15/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Impaired physical performance is a disturbing complication of acromegaly. We aimed to evaluate the role of regular exercise in amelioration of the impaired physical performance in acromegaly. METHODS Patients with acromegaly were divided into two groups according to their participation in a prescheduled programme of exercise. Participants in the study group were exercised 3 days a week for 3 consecutive months. Exercise tolerance was evaluated by maximal oxygen consumption (VO2 max) and time (T) taken to complete the Bruce protocol, muscle flexibility by the sit and reach test (SRT) and muscle strength by the hand grip strength test (HGST). Concomitantly, anthropometric assessment was performed using body mass index (BMI), waist-to-hip ratio (WHR), skinfold measurements from 8 points, percentage body fat (PBF), fat mass (FM) and lean body mass (LBM). RESULTS After 3 months of exercise, VO2 max and T were higher in cases that exercised than in cases that did not (P = 0.004 and P = 0.001). Over 3 months, within the exercise group, VO2 max and T of the Bruce protocol increased (P = 0.003 and P = 0.004) and heart rate during warming decreased (P = 0.04). SRT increased within the exercise group after 3 months (P = 0.004). HGSRT did not change significantly (right P = 0.06 and left P = 0.2). The sum of skinfolds, BMI, WHR and LBM remained stable over the study period (P = 0.1, P = 0.08, P = 0.3 and P = 0.09). PBF decreased slightly and FM decreased significantly over 3 months (P = 0.05 and P = 0.03). CONCLUSION Even short-term exercise may improve impaired physical performance, muscle activity and disturbed body fat composition in acromegaly.
Collapse
Affiliation(s)
- Esra Hatipoglu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
| | - Nuri Topsakal
- Marmara University School of Physical Education and Sports, Istanbul, Turkey
| | - Oya Erkut Atilgan
- Marmara University School of Physical Education and Sports, Istanbul, Turkey
| | | | - Baris Ikitimur
- Department of Cardiology, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
| | - Serdal Ugurlu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
| | - Mutlu Niyazoglu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
| | - Hasan Birol Cotuk
- Marmara University School of Physical Education and Sports, Istanbul, Turkey
| | - Pinar Kadioglu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
| |
Collapse
|
76
|
Felt JM, Depaoli SA, Pereira AM, Biermasz NR, Tiemensma J. Total score or subscales in scoring the acromegaly quality of life questionnaire: using novel confirmatory methods to compare scoring options. Eur J Endocrinol 2015; 173:37-42. [PMID: 25872514 DOI: 10.1530/eje-15-0228] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 04/13/2015] [Indexed: 11/08/2022]
Abstract
CONTEXT Impaired quality of life (QoL) is common in patients after long-term remission of acromegaly. The acromegaly QoL (AcroQoL) is a disease-specific QoL questionnaire for patients diagnosed with acromegaly. The summed total score is the most frequently used scoring method of the AcroQoL. However, the total score does not capture all of the aspects of QoL that are outlined by the World Health Organization (WHO). OBJECTIVE The aim of the present study was to use novel and sophisticated confirmatory methods to identify the optimal number of subscales for the AcroQoL. DESIGN AND PATIENTS Patients in remission from acromegaly were recruited from the Leiden University Medical Center and were asked to complete the AcroQoL (Dutch version) questionnaire (n=72). RESULTS The three-subscale version of the AcroQoL consisted of subscales reflecting Physical Complaints, Appearance Issues, and Personal Relations Issues related to QoL. Model fit indices (i.e., comparative fit index and root mean square error of approximation) indicated that the three-subscale version represented the data better than the total score and two-subscale models did. A χ(2) difference test indicated that the three-subscale model was a significantly better fit than the total score and two-subscale models were (P<0.05). CONCLUSION Model fit and comparison statistics indicate that the three-subscale model is a better scoring method than the total score and two-subscale versions of the AcroQoL are. The three-subscale version also better reflected the WHO's recommendation of using a multidimensional measure of QoL than the total score and two-subscale methods did. Therefore, it is recommended that values from the three-subscales of the AcroQoL be reported in future research.
Collapse
Affiliation(s)
- John M Felt
- Psychological SciencesSSHA, University of California, Merced, 5200 North Lake Road, Merced, California 95343, USADepartment of Endocrinology and MetabolismLeiden University Medical Center, Leiden, The Netherlands
| | - Sarah A Depaoli
- Psychological SciencesSSHA, University of California, Merced, 5200 North Lake Road, Merced, California 95343, USADepartment of Endocrinology and MetabolismLeiden University Medical Center, Leiden, The Netherlands
| | - Alberto M Pereira
- Psychological SciencesSSHA, University of California, Merced, 5200 North Lake Road, Merced, California 95343, USADepartment of Endocrinology and MetabolismLeiden University Medical Center, Leiden, The Netherlands
| | - Nienke R Biermasz
- Psychological SciencesSSHA, University of California, Merced, 5200 North Lake Road, Merced, California 95343, USADepartment of Endocrinology and MetabolismLeiden University Medical Center, Leiden, The Netherlands
| | - Jitske Tiemensma
- Psychological SciencesSSHA, University of California, Merced, 5200 North Lake Road, Merced, California 95343, USADepartment of Endocrinology and MetabolismLeiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
77
|
Chin SO, Chung CH, Chung YS, Kim BJ, Kim HY, Kim IJ, Kim JG, Kim MS, Kim SY, Lee EJ, Lee KY, Kim SW. Change in quality of life in patients with acromegaly after treatment with octreotide LAR: first application of AcroQoL in Korea. BMJ Open 2015; 5:e006898. [PMID: 26063564 PMCID: PMC4466761 DOI: 10.1136/bmjopen-2014-006898] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES This study was designed to investigate changes in health-related quality of life (HRQoL) of patients with acromegaly in Korea after medical treatment with octreotide LAR using the validated Korean version of the acromegaly quality of life questionnaire (AcroQoL). DESIGN A prospective, open-label, single-arm study. SETTING 11 tertiary centres in Korea. PARTICIPANTS 58 Korean patients (aged 21-72 years) who were newly diagnosed with acromegaly between 2009 and 2012 were prescribed octreotide LAR 20 mg at the time of enrolment. During 24 weeks of observation, AcroQoL survey questionnaires and measurement of growth hormone insulin-like growth factor 1(GH/IGF-I) were performed at baseline, week 12 and week 24. MAIN OUTCOME MEASURES We assessed the HRQoL of Korean patients with acromegaly after medical treatment with octreotide LAR using the validated Korean version of the AcroQoL questionnaire. RESULTS Patients had a mean age of 47.2 years (29 males), and GH and IGF-I significantly decreased during the first 12 weeks (GH: 4.8 vs 1.9 μg/L, p<0.001; IGF-I: 497 vs 265 μg/L, p<0.001), but showed insignificant change at week 24 (GH: 2.3 μg/L; IGF-I: 294 μg/L). Only AcroQoL scores for the psychological appearance subdomain showed a significant increase during the entire 24 weeks (p<0.05). The change in the psychological appearance subdomain of AcroQoL scores demonstrated a significant but weak negative correlation with change in IGF-I levels (r=-0.282, p=0.039). When patients were divided into two groups according to their disease activity at week 24 (controlled vs uncontrolled), there was no difference in AcroQoL scores, but the psychological appearance subdomain of the two groups appeared to change differently over the entire 24-week period (p=0.047). CONCLUSIONS Medical treatment with octreotide LAR in patients with acromegaly has a limited contribution to HRQoL as assessed by the AcroQoL.
Collapse
Affiliation(s)
- Sang Ouk Chin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Choon Hee Chung
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Korea
| | - Yoon-Sok Chung
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
| | - Byung-Joon Kim
- Department of Endocrinology and Metabolism, Gachon University Gil Medical Center, Incheon, Korea
| | - Hee Young Kim
- Division of Endocrinology and Metabolism, Department of Endocrinology, Korea University College of Medicine, Seoul, Korea
| | - In-Ju Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Jung Guk Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kyungpook University School of Medicine, Daegu, Korea
| | - Min-Seon Kim
- Department of Internal Medicine, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Seong-Yeon Kim
- Department of Internal Medicine, Seoul National University School of Medicine, Seoul, Korea
| | - Eun Jig Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ki Young Lee
- Department of Endocrinology and Metabolism, Gachon University Gil Medical Center, Incheon, Korea
| | - Sung-Woon Kim
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
| |
Collapse
|
78
|
Leistner SM, Klotsche J, Dimopoulou C, Athanasoulia AP, Roemmler-Zehrer J, Pieper L, Schopohl J, Wittchen HU, Stalla GK, Fulda S, Sievers C. Reduced sleep quality and depression associate with decreased quality of life in patients with pituitary adenomas. Eur J Endocrinol 2015; 172:733-43. [PMID: 25792374 DOI: 10.1530/eje-14-0941] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 03/19/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Several studies reported decreased quality of life (QoL) and sleep as well as increased rates of depression for patients with pituitary adenomas. Our aim was to explore to what extent differences in depression and sleep quality contribute to differences in QoL between patients with pituitary adenomas and controls. DESIGN A cross-sectional case-control study. SETTING Endocrine Outpatient Unit of the Max Planck Institute of Psychiatry, Munich, Department of Internal Medicine, Ludwig-Maximilians-University, Munich, and the Institute of Clinical Psychology and Psychotherapy, Technical University, Dresden. PARTICIPANTS Patients with pituitary adenomas (n=247) and controls (from the DETECT cohort, a large epidemiological study in primary care patients) matched individually by age and gender (n=757). MEASUREMENTS Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI) and QoL was measured by the generic EQ-5D and calculated by the time trade-off- and VAS-method. Depression was categorized as 'no depression', 'subclinical depression', and 'clinical depression' according to the Beck Depressions Inventory for patients and the Depression Screening Questionnaire for control subjects. STATISTICAL ANALYSES General linear and generalized, logistic mixed models as well as proportional odds mixed models were calculated for analyzing differences in baseline characteristics and in different subgroups. RESULTS Patients with pituitary adenomas showed decreased QoL (VAS index: 0.73±0.19) and sleep (PSQI score: 6.75±4.17) as well as increased rates of depression (subclinical or clinical depression: 41.4%) compared with their matched control subjects (VAS index: 0.79±0.18, PSQI score: 5.66±4.31, subclinical or clinical depression: 25.9%). We have shown that a substantial proportion of the reduced QoL (48% respectively 65%) was due to the incidence of depression and reduced sleep quality. CONCLUSIONS These findings emphasize the importance of diagnosing depressive symptoms and sleep disturbances in patients with pituitary disease, with the ultimate goal to improve QoL in patients with pituitary adenomas.
Collapse
Affiliation(s)
- Sarah M Leistner
- Department of EndocrinologyMax-Planck-Institute of Psychiatry, Kraepelinstraße 2-10, 80804 Munich, GermanyInstitute of Clinical Psychology and PsychotherapyCenter of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Straße 46, 01187 Dresden, GermanyMedizinische Klinik InnenstadtLudwig-Maximilians University, Ziemssenstraße 1, 80336 Munich, GermanySleep and Epilepsy CenterNeurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Via Tesserete 46, 6900 Lugano, SwitzerlandA Leibnitz InstituteGerman Rheumatism Research Center, Charitéplatz 1, 10117 Berlin, Germany
| | - Jens Klotsche
- Department of EndocrinologyMax-Planck-Institute of Psychiatry, Kraepelinstraße 2-10, 80804 Munich, GermanyInstitute of Clinical Psychology and PsychotherapyCenter of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Straße 46, 01187 Dresden, GermanyMedizinische Klinik InnenstadtLudwig-Maximilians University, Ziemssenstraße 1, 80336 Munich, GermanySleep and Epilepsy CenterNeurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Via Tesserete 46, 6900 Lugano, SwitzerlandA Leibnitz InstituteGerman Rheumatism Research Center, Charitéplatz 1, 10117 Berlin, Germany Department of EndocrinologyMax-Planck-Institute of Psychiatry, Kraepelinstraße 2-10, 80804 Munich, GermanyInstitute of Clinical Psychology and PsychotherapyCenter of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Straße 46, 01187 Dresden, GermanyMedizinische Klinik InnenstadtLudwig-Maximilians University, Ziemssenstraße 1, 80336 Munich, GermanySleep and Epilepsy CenterNeurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Via Tesserete 46, 6900 Lugano, SwitzerlandA Leibnitz InstituteGerman Rheumatism Research Center, Charitéplatz 1, 10117 Berlin, Germany
| | - Christina Dimopoulou
- Department of EndocrinologyMax-Planck-Institute of Psychiatry, Kraepelinstraße 2-10, 80804 Munich, GermanyInstitute of Clinical Psychology and PsychotherapyCenter of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Straße 46, 01187 Dresden, GermanyMedizinische Klinik InnenstadtLudwig-Maximilians University, Ziemssenstraße 1, 80336 Munich, GermanySleep and Epilepsy CenterNeurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Via Tesserete 46, 6900 Lugano, SwitzerlandA Leibnitz InstituteGerman Rheumatism Research Center, Charitéplatz 1, 10117 Berlin, Germany
| | - Anastasia P Athanasoulia
- Department of EndocrinologyMax-Planck-Institute of Psychiatry, Kraepelinstraße 2-10, 80804 Munich, GermanyInstitute of Clinical Psychology and PsychotherapyCenter of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Straße 46, 01187 Dresden, GermanyMedizinische Klinik InnenstadtLudwig-Maximilians University, Ziemssenstraße 1, 80336 Munich, GermanySleep and Epilepsy CenterNeurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Via Tesserete 46, 6900 Lugano, SwitzerlandA Leibnitz InstituteGerman Rheumatism Research Center, Charitéplatz 1, 10117 Berlin, Germany
| | - Josefine Roemmler-Zehrer
- Department of EndocrinologyMax-Planck-Institute of Psychiatry, Kraepelinstraße 2-10, 80804 Munich, GermanyInstitute of Clinical Psychology and PsychotherapyCenter of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Straße 46, 01187 Dresden, GermanyMedizinische Klinik InnenstadtLudwig-Maximilians University, Ziemssenstraße 1, 80336 Munich, GermanySleep and Epilepsy CenterNeurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Via Tesserete 46, 6900 Lugano, SwitzerlandA Leibnitz InstituteGerman Rheumatism Research Center, Charitéplatz 1, 10117 Berlin, Germany
| | - Lars Pieper
- Department of EndocrinologyMax-Planck-Institute of Psychiatry, Kraepelinstraße 2-10, 80804 Munich, GermanyInstitute of Clinical Psychology and PsychotherapyCenter of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Straße 46, 01187 Dresden, GermanyMedizinische Klinik InnenstadtLudwig-Maximilians University, Ziemssenstraße 1, 80336 Munich, GermanySleep and Epilepsy CenterNeurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Via Tesserete 46, 6900 Lugano, SwitzerlandA Leibnitz InstituteGerman Rheumatism Research Center, Charitéplatz 1, 10117 Berlin, Germany
| | - Jochen Schopohl
- Department of EndocrinologyMax-Planck-Institute of Psychiatry, Kraepelinstraße 2-10, 80804 Munich, GermanyInstitute of Clinical Psychology and PsychotherapyCenter of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Straße 46, 01187 Dresden, GermanyMedizinische Klinik InnenstadtLudwig-Maximilians University, Ziemssenstraße 1, 80336 Munich, GermanySleep and Epilepsy CenterNeurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Via Tesserete 46, 6900 Lugano, SwitzerlandA Leibnitz InstituteGerman Rheumatism Research Center, Charitéplatz 1, 10117 Berlin, Germany
| | - Hans-Ulrich Wittchen
- Department of EndocrinologyMax-Planck-Institute of Psychiatry, Kraepelinstraße 2-10, 80804 Munich, GermanyInstitute of Clinical Psychology and PsychotherapyCenter of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Straße 46, 01187 Dresden, GermanyMedizinische Klinik InnenstadtLudwig-Maximilians University, Ziemssenstraße 1, 80336 Munich, GermanySleep and Epilepsy CenterNeurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Via Tesserete 46, 6900 Lugano, SwitzerlandA Leibnitz InstituteGerman Rheumatism Research Center, Charitéplatz 1, 10117 Berlin, Germany
| | - Günter K Stalla
- Department of EndocrinologyMax-Planck-Institute of Psychiatry, Kraepelinstraße 2-10, 80804 Munich, GermanyInstitute of Clinical Psychology and PsychotherapyCenter of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Straße 46, 01187 Dresden, GermanyMedizinische Klinik InnenstadtLudwig-Maximilians University, Ziemssenstraße 1, 80336 Munich, GermanySleep and Epilepsy CenterNeurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Via Tesserete 46, 6900 Lugano, SwitzerlandA Leibnitz InstituteGerman Rheumatism Research Center, Charitéplatz 1, 10117 Berlin, Germany
| | - Stephany Fulda
- Department of EndocrinologyMax-Planck-Institute of Psychiatry, Kraepelinstraße 2-10, 80804 Munich, GermanyInstitute of Clinical Psychology and PsychotherapyCenter of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Straße 46, 01187 Dresden, GermanyMedizinische Klinik InnenstadtLudwig-Maximilians University, Ziemssenstraße 1, 80336 Munich, GermanySleep and Epilepsy CenterNeurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Via Tesserete 46, 6900 Lugano, SwitzerlandA Leibnitz InstituteGerman Rheumatism Research Center, Charitéplatz 1, 10117 Berlin, Germany Department of EndocrinologyMax-Planck-Institute of Psychiatry, Kraepelinstraße 2-10, 80804 Munich, GermanyInstitute of Clinical Psychology and PsychotherapyCenter of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Straße 46, 01187 Dresden, GermanyMedizinische Klinik InnenstadtLudwig-Maximilians University, Ziemssenstraße 1, 80336 Munich, GermanySleep and Epilepsy CenterNeurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Via Tesserete 46, 6900 Lugano, SwitzerlandA Leibnitz InstituteGerman Rheumatism Research Center, Charitéplatz 1, 10117 Berlin, Germany
| | - Caroline Sievers
- Department of EndocrinologyMax-Planck-Institute of Psychiatry, Kraepelinstraße 2-10, 80804 Munich, GermanyInstitute of Clinical Psychology and PsychotherapyCenter of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Straße 46, 01187 Dresden, GermanyMedizinische Klinik InnenstadtLudwig-Maximilians University, Ziemssenstraße 1, 80336 Munich, GermanySleep and Epilepsy CenterNeurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Via Tesserete 46, 6900 Lugano, SwitzerlandA Leibnitz InstituteGerman Rheumatism Research Center, Charitéplatz 1, 10117 Berlin, Germany
| |
Collapse
|
79
|
Tiemensma J, Pereira AM, Romijn JA, Broadbent E, Biermasz NR, Kaptein AA. Persistent negative illness perceptions despite long-term biochemical control of acromegaly: novel application of the drawing test. Eur J Endocrinol 2015; 172:583-93. [PMID: 25724922 DOI: 10.1530/eje-14-0996] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
CONTEXT AND OBJECTIVE Patients with acromegaly have persistent complaints despite long-term biochemical control. Drawings can be used to assess patients' perceptions about their disease. We aimed to explore the utility of the drawing test and its relation to illness perceptions and quality of life (QoL) in patients after long-term remission of acromegaly. DESIGN A cross-sectional study was conducted to evaluate the utility of the drawing test. METHODS A total of 50 patients after long-term remission (mean±s.e.m., 16±1.2 years) of acromegaly were included in this study. Patients completed the drawing test (two retrospective drawings of their body perception before acromegaly and during the active phase of acromegaly, and one drawing on the current condition after long-term remission), Illness Perception Questionnaire-Revised, Physical Symptom Checklist, EuroQoL-5D, and AcroQoL. RESULTS Patients perceived a dramatic change in body size during the active state of the disease compared with the healthy state before the awareness of acromegaly. Patients reported that their body did not completely return to the original proportions after long-term remission. In addition, larger drawings indicated more negative consequences (P<0.05), a higher score on emotional representations (P<0.05), and more perceived symptoms that were attributed to acromegaly (P<0.01). Larger drawings also indicated more impaired QoL, especially disease-specific QoL (all P<0.05). CONCLUSION There are strong correlations among the drawing test, illness perceptions, and QoL. The drawing test appears to be a novel and relatively easy tool to assess the perception of patients after long-term remission of acromegaly. The assessment of drawings may enable health care providers to appreciate the perceptions of patients with long-term remission of acromegaly, and enable discussion of symptoms and remission.
Collapse
Affiliation(s)
- Jitske Tiemensma
- Psychological ScienceUniversity of California Merced, 5200 North Lake Road, Merced, California 95343, USADepartment of Endocrinology & Metabolism and Center for Endocrine Tumors Leiden (CETL)Leiden University Medical Center, Leiden, The NetherlandsDepartment of MedicineAcademic Medical Center, University of Amsterdam, Amsterdam, The NetherlandsDepartment of Psychological MedicineUniversity of Auckland, Auckland, New ZealandDepartment of Medical PsychologyLeiden University Medical Center, Leiden, The Netherlands Psychological ScienceUniversity of California Merced, 5200 North Lake Road, Merced, California 95343, USADepartment of Endocrinology & Metabolism and Center for Endocrine Tumors Leiden (CETL)Leiden University Medical Center, Leiden, The NetherlandsDepartment of MedicineAcademic Medical Center, University of Amsterdam, Amsterdam, The NetherlandsDepartment of Psychological MedicineUniversity of Auckland, Auckland, New ZealandDepartment of Medical PsychologyLeiden University Medical Center, Leiden, The Netherlands
| | - Alberto M Pereira
- Psychological ScienceUniversity of California Merced, 5200 North Lake Road, Merced, California 95343, USADepartment of Endocrinology & Metabolism and Center for Endocrine Tumors Leiden (CETL)Leiden University Medical Center, Leiden, The NetherlandsDepartment of MedicineAcademic Medical Center, University of Amsterdam, Amsterdam, The NetherlandsDepartment of Psychological MedicineUniversity of Auckland, Auckland, New ZealandDepartment of Medical PsychologyLeiden University Medical Center, Leiden, The Netherlands
| | - Johannes A Romijn
- Psychological ScienceUniversity of California Merced, 5200 North Lake Road, Merced, California 95343, USADepartment of Endocrinology & Metabolism and Center for Endocrine Tumors Leiden (CETL)Leiden University Medical Center, Leiden, The NetherlandsDepartment of MedicineAcademic Medical Center, University of Amsterdam, Amsterdam, The NetherlandsDepartment of Psychological MedicineUniversity of Auckland, Auckland, New ZealandDepartment of Medical PsychologyLeiden University Medical Center, Leiden, The Netherlands
| | - Elizabeth Broadbent
- Psychological ScienceUniversity of California Merced, 5200 North Lake Road, Merced, California 95343, USADepartment of Endocrinology & Metabolism and Center for Endocrine Tumors Leiden (CETL)Leiden University Medical Center, Leiden, The NetherlandsDepartment of MedicineAcademic Medical Center, University of Amsterdam, Amsterdam, The NetherlandsDepartment of Psychological MedicineUniversity of Auckland, Auckland, New ZealandDepartment of Medical PsychologyLeiden University Medical Center, Leiden, The Netherlands
| | - Nienke R Biermasz
- Psychological ScienceUniversity of California Merced, 5200 North Lake Road, Merced, California 95343, USADepartment of Endocrinology & Metabolism and Center for Endocrine Tumors Leiden (CETL)Leiden University Medical Center, Leiden, The NetherlandsDepartment of MedicineAcademic Medical Center, University of Amsterdam, Amsterdam, The NetherlandsDepartment of Psychological MedicineUniversity of Auckland, Auckland, New ZealandDepartment of Medical PsychologyLeiden University Medical Center, Leiden, The Netherlands
| | - Adrian A Kaptein
- Psychological ScienceUniversity of California Merced, 5200 North Lake Road, Merced, California 95343, USADepartment of Endocrinology & Metabolism and Center for Endocrine Tumors Leiden (CETL)Leiden University Medical Center, Leiden, The NetherlandsDepartment of MedicineAcademic Medical Center, University of Amsterdam, Amsterdam, The NetherlandsDepartment of Psychological MedicineUniversity of Auckland, Auckland, New ZealandDepartment of Medical PsychologyLeiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
80
|
Ritvonen E, Karppinen A, Sintonen H, Vehkavaara S, Kivipelto L, Roine RP, Niemelä M, Schalin-Jäntti C. Normal long-term health-related quality of life can be achieved in patients with functional pituitary adenomas having surgery as primary treatment. Clin Endocrinol (Oxf) 2015; 82:412-21. [PMID: 25039500 DOI: 10.1111/cen.12550] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 06/18/2014] [Accepted: 07/06/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND Previous studies report impaired health-related quality of life (HRQoL) in patients with functional pituitary adenomas (FPA). We assessed HRQoL in FPA patients having undergone surgery at our University Central Hospital between 2000 and 2010, with combined adjuvant treatment given to achieve strict hormonal control. DESIGN A cross-sectional study including a large control population. PATIENTS AND METHODS HRQoL was assessed by the 15D in 100 FPA patients (acromegaly n = 47, Cushing's disease n = 21, prolactinoma n = 26, TSH-adenoma n = 2, gonadotropinoma n = 4), operated on a mean 7·4 (range 2·1-13·0) years earlier. An age- and gender-standardized sample of the general population (n = 4924) served as controls. HRQoL determinants were assessed by independent samples t-test and multiple regression analysis. RESULTS Hormonal remission rate was 90·9% and 43·9% of the patients received replacement therapy. The mean 15D scores were similar in patients and controls (0·917 vs 0·922, P = 0·568). On single dimensions, patients were worse off regarding speech and sexual activity (both P < 0·05) and better off regarding discomfort and symptoms (P < 0·05). Age (P = 0·001), co-morbidities (P = 0·009), Cushing's disease (P = 0·034), and thyroxine dose (P = 0·002) predicted impaired HRQoL, but not hypopituitarism, hydrocortisone replacement, radiotherapy, or time after surgery. CONCLUSIONS It is possible to achieve near-normal HRQoL in surgically treated FPA patients given adjuvant treatment to achieve strict hormonal remission. However, in addition to age and co-morbidities, Cushing's disease and need for thyroxine replacement therapy predict impaired HRQoL.
Collapse
Affiliation(s)
- Elina Ritvonen
- Division of Endocrinology, Department of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | | | | | | | | | | | | | | |
Collapse
|
81
|
Abstract
The management of acromegaly caused by an uncommon growth hormone-secreting pituitary adenoma can be challenging in low-resource African subregion. We conducted a study over a 2-year period to describe the results and challenges following surgical treatment of this rare condition in our centre. The clinical outcome was defined as successful based on the surgeon's intraoperative observation, postoperative neuroimaging findings and neuroendocrinological results. A total of three patients (two males and one female) aged 19-32 years were included. Visual impairment was the main presenting symptom in all the three patients. The postoperative period was uneventful. Acromegaly is an uncommon disorder in our region. Surgery is the treatment of choice in low-resource practice.
Collapse
Affiliation(s)
- Idowu Olufemi Emmanuel
- Department of Surgery, Neurosurgery Division, Lagos State University College of Medicine, Lagos, Nigeria
| | - Audu Safina Mary-Anne
- Department of Family Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| |
Collapse
|
82
|
Andela CD, Niemeijer ND, Scharloo M, Tiemensma J, Kanagasabapathy S, Pereira AM, Kamminga NGA, Kaptein AA, Biermasz NR. Towards a better quality of life (QoL) for patients with pituitary diseases: results from a focus group study exploring QoL. Pituitary 2015; 18:86-100. [PMID: 24682940 DOI: 10.1007/s11102-014-0561-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Patients treated for pituitary adenomas generally report a reduced quality of life (QoL). At present, the patient's perspective of QoL has not been fully addressed and this, and further insight in potential determinants of QoL in pituitary diseases is required to design strategies to improve QoL. We aimed to define patients' perceived QoL and to identify potential factors they perceive to contribute to QoL. METHODS We conducted four independent focus groups of six patients each, per specific pituitary disease (Cushing's disease, Non-functioning pituitary macroadenoma, acromegaly, prolactinoma). In two sessions these focus groups discussed aspects of QoL. Verbatim transcripts were analyzed using a grounded theory approach. RESULTS The issues raised by the patient groups were compatible with statements and items of available QoL questionnaires. In addition, other QoL aspects emerged, such as visual limitations (physical problems); issues with a desire to have children/family planning, fear of collapsing, fear of recurrence, panic, persisting thoughts, problems with an altered personality, anger, jealousy, sadness, frustration (psychological problems); and difficulties communicating about the disease, lack of sympathy and understanding by others, and a reduced social network (social problems). Next, this study uncovered factors which might contribute to a decreased QoL (e.g. less effective coping strategies, negative illness perceptions, negative beliefs about medicines, unmet needs regarding care). CONCLUSIONS This focus group study demonstrated that important disease-specific aspects of QoL are neglected in current pituitary disease-specific questionnaires and elucidated potential factors that contribute to a decreased QoL. Information provided in this study can (and will) be used for developing additional items for disease-specific QoL questionnaires and for the development of a self-management intervention aiming to improve QoL in patients treated for pituitary diseases.
Collapse
Affiliation(s)
- Cornelie D Andela
- Department of Endocrinology and Metabolic Diseases and Center for Endocrine Tumors Leiden, Leiden University Medical Center, Leiden, The Netherlands,
| | | | | | | | | | | | | | | | | |
Collapse
|
83
|
Conaglen HM, de Jong D, Crawford V, Elston MS, Conaglen JV. Body Image Disturbance in Acromegaly Patients Compared to Nonfunctioning Pituitary Adenoma Patients and Controls. Int J Endocrinol 2015; 2015:624872. [PMID: 26078758 PMCID: PMC4452843 DOI: 10.1155/2015/624872] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 05/10/2015] [Indexed: 12/03/2022] Open
Abstract
Purpose. Excess growth hormone secretion in adults results in acromegaly, a condition in which multiple physical changes occur including bony and soft tissue overgrowth. Over time these changes can markedly alter a person's appearance. The aim of this study was to compare body image disturbance in patients with acromegaly to those with nonfunctioning pituitary adenomas (NFAs) and controls and assess the impact of obesity in these groups. Methods. A cross-sectional survey including quality of life, body image disturbance, anxiety and depression measures, growth hormone, and BMI measurement was carried out. Results. The groups did not differ with respect to body image disturbance. However separate analysis of obese participants demonstrated relationships between mood scales, body image disturbance, and pain issues, particularly for acromegaly patients. Conclusions. While the primary hypothesis that acromegaly might be associated with body image disturbance was not borne out, we have shown that obesity together with acromegaly and NFA can be associated with body image issues, suggesting that BMI rather than primary diagnosis might better indicate whether patients might experience body image disturbance problems.
Collapse
Affiliation(s)
- Helen M. Conaglen
- Waikato Clinical School, University of Auckland, Private Bag 3200, Hamilton 3240, New Zealand
- *Helen M. Conaglen:
| | - Dennis de Jong
- University of Waikato, Private Bag 3105, Hamilton 3240, New Zealand
| | | | - Marianne S. Elston
- Waikato Clinical School, University of Auckland, Private Bag 3200, Hamilton 3240, New Zealand
- Waikato Hospital, Private Bag 3200, Hamilton 3240, New Zealand
| | - John V. Conaglen
- Waikato Clinical School, University of Auckland, Private Bag 3200, Hamilton 3240, New Zealand
- Waikato Hospital, Private Bag 3200, Hamilton 3240, New Zealand
| |
Collapse
|
84
|
Kepicoglu H, Hatipoglu E, Bulut I, Darici E, Hizli N, Kadioglu P. Impact of treatment satisfaction on quality of life of patients with acromegaly. Pituitary 2014; 17:557-63. [PMID: 24337714 DOI: 10.1007/s11102-013-0544-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To evaluate satisfaction of acromegalic subjects with their medical treatment and its contribution to their quality of life. METHODS This cross-sectional study included a total of 159 medications used in 133 subjects with acromegaly (controlled n = 84 and uncontrolled n = 49, female/male: 81/52). Subjects were asked to complete questionnaires on symptoms of depression (BDI) and satisfaction with the medical therapy they received for acromegaly (TSQM). Acromegaly cases also completed Acromegaly Quality of Life Questionnaire (AcroQoL). RESULTS Subjects on pegvisomant therapy scored lower on convenience (p = 0.007). Cases on combination therapy had lower domain scores for effectiveness, convenience and global satisfaction in comparison to the cases on monotherapy (p = 0.01, p = 0.01 and p = 0.01, respectively). The time elapsed since diagnosis and the duration of medical therapy were positively correlated with effectiveness score (r = 0.2, p = 0.007 and r = 0.2, p = 0.04, respectively). The AcroQoL score was positively correlated with all domains of TSQM (for effectiveness r = 0.2, p = 0.01; for side effects r = 0.3, p = 0.001; for convenience r = 0.3, p = 0.004 and for global satisfaction r = 0.2, p = 0.01). In contrast, the BDI score was inversely correlated with all domains of TSQM (for effectiveness r = -0.3, p = 0.001; for side effects r = -0.2, p = 0.006; for convenience r = -0.3, p < 0.001 and for global satisfaction r = -0.3, p = 0.001). CONCLUSION In acromegaly, quality of life, status of depression and satisfaction of the subjects with their treatment are intercorrelated.
Collapse
Affiliation(s)
- Hasan Kepicoglu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
| | | | | | | | | | | |
Collapse
|
85
|
Anagnostis P, Efstathiadou ZA, Charizopoulou M, Selalmatzidou D, Karathanasi E, Poulasouchidou M, Kita M. Psychological profile and quality of life in patients with acromegaly in Greece. Is there any difference with other chronic diseases? Endocrine 2014; 47:564-71. [PMID: 24510628 DOI: 10.1007/s12020-014-0166-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 01/04/2014] [Indexed: 02/06/2023]
Abstract
Several studies have shown that acromegaly is associated with increased psychological morbidity. However, it is not known whether this is attributed to acromegaly per se or to its chronicity as a debilitating disease affecting quality of life (QoL). The aim of this study was to assess psychological profile in acromegalics compared with those suffering from other serious chronic diseases and healthy controls. Secondary end points were QoL assessment and its association with mood disturbances. Comparative, cross-sectional study conducted in Northern Greece (2011-2012). The Greek versions of the Profile of Mood States (POMS) and AcroQoL questionnaires were used to assess psychological status and QoL, respectively. Forty acromegalics, 40 age- and sex-matched people with other chronic diseases and 80 healthy controls were included. No significant differences were identified between acromegalics and those suffering from other chronic diseases, regarding tension, anger, depression, confusion, fatigue and vigor. Compared with healthy controls, acromegalics suffered more from depression and anger, which remained significant after controlling for age, gender and marital status (p = 0.003 and p = 0.048, respectively). Negative predictors were female gender, macroadenomas and radiotherapy. AcroQoL scores were negatively associated with POMS subscales. Males had better QoL than females. Other than a negative association between AcroQoL-relationships subscale and disease duration, no association with other parameters was observed. Acromegaly has a negative impact on psychological status, which is worse than that of general population, but comparable to other chronic diseases. Mood disturbances are associated with impaired QoL, mainly in females and those with longer disease duration.
Collapse
Affiliation(s)
- Panagiotis Anagnostis
- Department of Endocrinology, Hippokration Hospital of Thessaloniki, Sarantaporou 10, 54640, Thessaloniki, Greece,
| | | | | | | | | | | | | |
Collapse
|
86
|
Dimopoulou C, Athanasoulia AP, Hanisch E, Held S, Sprenger T, Toelle TR, Roemmler-Zehrer J, Schopohl J, Stalla GK, Sievers C. Clinical characteristics of pain in patients with pituitary adenomas. Eur J Endocrinol 2014; 171:581-91. [PMID: 25117460 DOI: 10.1530/eje-14-0375] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Clinical presentation of pituitary adenomas frequently involves pain, particularly headache, due to structural and functional properties of the tumour. Our aim was to investigate the clinical characteristics of pain in a large cohort of patients with pituitary disease. DESIGN In a cross-sectional study, we assessed 278 patients with pituitary disease (n=81 acromegaly; n=45 Cushing's disease; n=92 prolactinoma; n=60 non-functioning pituitary adenoma). METHODS Pain was studied using validated questionnaires to screen for nociceptive vs neuropathic pain components (painDETECT), determine pain severity, quality, duration and location (German pain questionnaire) and to assess the impact of pain on disability (migraine disability assessment, MIDAS) and quality of life (QoL). RESULTS We recorded a high prevalence of bodily pain (n=180, 65%) and headache (n=178, 64%); adrenocorticotropic adenomas were most frequently associated with pain (n=34, 76%). Headache was equally frequent in patients with macro- and microadenomas (68 vs 60%; P=0.266). According to painDETECT, the majority of the patients had a nociceptive pain component (n=193, 80%). Despite high prevalence of headache, 72% reported little or no headache-related disability (MIDAS). Modifiable factors including tumour size, genetic predisposition, previous surgery, irradiation or medical therapy did not have significant impact neither on neuropathic pain components (painDETECT) nor on headache-related disability (MIDAS). Neuropathic pain and pain-related disability correlated significantly with depression and impaired QoL. CONCLUSIONS Pain appears to be a frequent problem in pituitary disease. The data suggest that pain should be integrated in the diagnostic and therapeutic work-up of patients with pituitary disease in order to treat them appropriately and improve their QoL.
Collapse
Affiliation(s)
- C Dimopoulou
- Department of EndocrinologyMax Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804 Munich, GermanyDepartment of NeurologyTechnische Universität München, Munich, GermanyMedizinische Klinik und Poliklinik IVLudwig-Maximilians-University, Munich, GermanyDepartment of NeurologyUniversity Hospital Basel, Basel, SwitzerlandDivision of NeuroradiologyDepartment of Radiology, University Hospital Basel, Basel, Switzerland
| | - A P Athanasoulia
- Department of EndocrinologyMax Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804 Munich, GermanyDepartment of NeurologyTechnische Universität München, Munich, GermanyMedizinische Klinik und Poliklinik IVLudwig-Maximilians-University, Munich, GermanyDepartment of NeurologyUniversity Hospital Basel, Basel, SwitzerlandDivision of NeuroradiologyDepartment of Radiology, University Hospital Basel, Basel, Switzerland Department of EndocrinologyMax Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804 Munich, GermanyDepartment of NeurologyTechnische Universität München, Munich, GermanyMedizinische Klinik und Poliklinik IVLudwig-Maximilians-University, Munich, GermanyDepartment of NeurologyUniversity Hospital Basel, Basel, SwitzerlandDivision of NeuroradiologyDepartment of Radiology, University Hospital Basel, Basel, Switzerland
| | - E Hanisch
- Department of EndocrinologyMax Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804 Munich, GermanyDepartment of NeurologyTechnische Universität München, Munich, GermanyMedizinische Klinik und Poliklinik IVLudwig-Maximilians-University, Munich, GermanyDepartment of NeurologyUniversity Hospital Basel, Basel, SwitzerlandDivision of NeuroradiologyDepartment of Radiology, University Hospital Basel, Basel, Switzerland
| | - S Held
- Department of EndocrinologyMax Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804 Munich, GermanyDepartment of NeurologyTechnische Universität München, Munich, GermanyMedizinische Klinik und Poliklinik IVLudwig-Maximilians-University, Munich, GermanyDepartment of NeurologyUniversity Hospital Basel, Basel, SwitzerlandDivision of NeuroradiologyDepartment of Radiology, University Hospital Basel, Basel, Switzerland
| | - T Sprenger
- Department of EndocrinologyMax Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804 Munich, GermanyDepartment of NeurologyTechnische Universität München, Munich, GermanyMedizinische Klinik und Poliklinik IVLudwig-Maximilians-University, Munich, GermanyDepartment of NeurologyUniversity Hospital Basel, Basel, SwitzerlandDivision of NeuroradiologyDepartment of Radiology, University Hospital Basel, Basel, Switzerland Department of EndocrinologyMax Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804 Munich, GermanyDepartment of NeurologyTechnische Universität München, Munich, GermanyMedizinische Klinik und Poliklinik IVLudwig-Maximilians-University, Munich, GermanyDepartment of NeurologyUniversity Hospital Basel, Basel, SwitzerlandDivision of NeuroradiologyDepartment of Radiology, University Hospital Basel, Basel, Switzerland Department of EndocrinologyMax Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804 Munich, GermanyDepartment of NeurologyTechnische Universität München, Munich, GermanyMedizinische Klinik und Poliklinik IVLudwig-Maximilians-University, Munich, GermanyDepartment of NeurologyUniversity Hospital Basel, Basel, SwitzerlandDivision of NeuroradiologyDepartment of Radiology, University Hospital Basel, Basel, Switzerland
| | - T R Toelle
- Department of EndocrinologyMax Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804 Munich, GermanyDepartment of NeurologyTechnische Universität München, Munich, GermanyMedizinische Klinik und Poliklinik IVLudwig-Maximilians-University, Munich, GermanyDepartment of NeurologyUniversity Hospital Basel, Basel, SwitzerlandDivision of NeuroradiologyDepartment of Radiology, University Hospital Basel, Basel, Switzerland
| | - J Roemmler-Zehrer
- Department of EndocrinologyMax Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804 Munich, GermanyDepartment of NeurologyTechnische Universität München, Munich, GermanyMedizinische Klinik und Poliklinik IVLudwig-Maximilians-University, Munich, GermanyDepartment of NeurologyUniversity Hospital Basel, Basel, SwitzerlandDivision of NeuroradiologyDepartment of Radiology, University Hospital Basel, Basel, Switzerland
| | - J Schopohl
- Department of EndocrinologyMax Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804 Munich, GermanyDepartment of NeurologyTechnische Universität München, Munich, GermanyMedizinische Klinik und Poliklinik IVLudwig-Maximilians-University, Munich, GermanyDepartment of NeurologyUniversity Hospital Basel, Basel, SwitzerlandDivision of NeuroradiologyDepartment of Radiology, University Hospital Basel, Basel, Switzerland
| | - G K Stalla
- Department of EndocrinologyMax Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804 Munich, GermanyDepartment of NeurologyTechnische Universität München, Munich, GermanyMedizinische Klinik und Poliklinik IVLudwig-Maximilians-University, Munich, GermanyDepartment of NeurologyUniversity Hospital Basel, Basel, SwitzerlandDivision of NeuroradiologyDepartment of Radiology, University Hospital Basel, Basel, Switzerland
| | - C Sievers
- Department of EndocrinologyMax Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804 Munich, GermanyDepartment of NeurologyTechnische Universität München, Munich, GermanyMedizinische Klinik und Poliklinik IVLudwig-Maximilians-University, Munich, GermanyDepartment of NeurologyUniversity Hospital Basel, Basel, SwitzerlandDivision of NeuroradiologyDepartment of Radiology, University Hospital Basel, Basel, Switzerland
| |
Collapse
|
87
|
Dantas RAE, Passos KE, Porto LB, Zakir JCO, 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. ACTA ACUST UNITED AC 2014; 57:550-7. [PMID: 24232821 DOI: 10.1590/s0004-27302013000700009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 03/25/2013] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To evaluate the quality of life and its association with daily physical activity and disease control in acromegalic patients. SUBJECTS AND METHODS A cross-sectional, case series study, composed of 42 patients recruited from the Neuroendocrinology Unit of the University Hospital of Brasilia. Level of physical activity was accessed by the International Physical Activity Questionnaire (IPAQ 6-short-form), which evaluates the weekly time spent on physical activity of moderate to vigorous intensity in different contexts of life. Quality of life was evaluated by The Medical Outcome Study Questionnaire Short Form (SF-36). Data was compared to growth hormone (GH) and insulin-like growth factor (IGF-1) levels. Students' t test and Fisher test were used, p < 0.05, SPSS 17.0. RESULTS Twenty-two women, aged 51.33 ± 14.33 and 20 men, aged 46.2 ± 13.18 were evaluated. Arthralgia was present in 83% of cases. In men, the most common sites of pain were the knees (73%), spine (47% lumbar, and 53% thoracic and cervical segments), hands and wrists (40%). Higher scores on SF-36 were observed in patients with intermediate or high levels of physical activity, in the domains social functioning (75 CI 57.3-92.6), general health (75.5 CI 60.4-90.5), mental health (70 CI 57.8-82.1). CONCLUSIONS In this study, the presence and severity of physical disability and pain were not associated with initial GH and IGF-1 levels or time of exposure to GH excess. However, the patients considered controlled, with normal a normal age-adjusted IGF-1, presented higher scores in SF-36, in physical and emotional domains, compared with patients with persistent hypersomatotrophism. These findings suggest benefits of metabolic control in self-reported quality of life.
Collapse
|
88
|
Alobid I, Enseñat J, Mariño-Sánchez F, Rioja E, de Notaris M, Mullol J, Bernal-Sprekelsen M. Expanded endonasal approach using vascularized septal flap reconstruction for skull base tumors has a negative impact on sinonasal symptoms and quality of life. Am J Rhinol Allergy 2014; 27:426-31. [PMID: 24119608 DOI: 10.2500/ajra.2013.27.3932] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Endoscopic transsphenoidal surgery is currently the optimal treatment for skull base tumors. This study was designed to assess patient's sinonasal symptoms and quality of life (QoL) after resection of pituitary adenoma or skull base tumors using vascularized septal flap (VSF) reconstruction. METHODS Patients with pituitary adenoma underwent the transnasal transsphenoidal endoscopic approach (TTEA; n = 38), and patients with other benign parasellar tumors underwent the expanded endonasal approach (EEA; n = 17) with VSF. Assessment of sinonasal symptoms and QoL by the 36-item Short-Form (SF-36) and the 31-item Rhinosinusitis Outcome Measure (RSOM-31) were performed before and 3 months after surgery. RESULTS At baseline, the total seven-sinonasal symptom score (T7SSS) was similar between both groups. After surgery, T7SSS significantly increased in EEA but not in TTEA patients. EEA patients reported more smell loss (40.1 ± 26.2; p < 0.05) and posterior nasal discharge (49.3 ± 30.1; p < 0.05) than TTEA patients (21.6 ± 30.9 and 22.5 ± 27.5, respectively). At baseline, both groups had poorer SF-36 compared with the general population. TTEA patients had poorer QoL (on general health, vitality, and mental health) than EEA patients. After surgery, TTEA patients showed impaired physical role and bodily pain compared with baseline, and EEA patients showed impaired physical role and mental health. At baseline, RSOM scores were similar in TTEA and EEA groups. After surgery, EEA but not TTEA patients reported poorer nasal and general symptoms. CONCLUSION The EEA with VSF produces more sinonasal symptoms than pituitary surgery, surgery for skull base and pituitary tumors has negative impact on QoL, and functioning tumors have no further negative effect on sinonasal symptoms and QoL.
Collapse
Affiliation(s)
- Isam Alobid
- Rhinology Unit and Smell Clinic, Ear, Nose, and Throat Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | | | | | | | | | | | | |
Collapse
|
89
|
Hatipoglu E, Topsakal N, Atilgan OE, Alcalar N, Camliguney AF, Niyazoglu M, Cotuk HB, Kadioglu P. Impact of exercise on quality of life and body-self perception of patients with acromegaly. Pituitary 2014; 17:38-43. [PMID: 23377883 DOI: 10.1007/s11102-013-0463-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In acromegaly the impact of therapy on well-being and self-perception of patients is not clearly defined. The data existing on the effect of treatment on health-related quality of life in patients with acromegaly is inconclusive. In this study we addressed the effect of exercise on health-related quality of life, symptoms of depression and perception of body image in patients with acromegaly. Patients with acromegaly were stratified into two groups according to their participation in a prescheduled program of exercise. Participants in the study group performed exercise for 75 min a day for 3 days a week during cosecutive 3 months. Warming, cardio, strength, balance and stretching moves applied in every course. Both the exercise group and control group were asked to complete a questionnaire on quality of life, symptoms of depression and self-perception of body image. Each questionnaire was answered by both groups before the beginning of the exercise program (at month-0) and after the completion of the program (at month-3). In exercise group after the completion of exercise period there was a tendency towards decreament in body mass index and IGF-I, although not statistically significant (p = 0.08 and p = 0.09). Self-assessment of body image improved significantly after participation in the exercise program (p = 0.01). Present findings support that exercise may be an adjunctive method for patients with acromegaly to improve self esteem and perception.
Collapse
Affiliation(s)
- Esra Hatipoglu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
| | | | | | | | | | | | | | | |
Collapse
|
90
|
Claessen KMJA, Ramautar SR, Pereira AM, Romijn JA, Kroon HM, Kloppenburg M, Biermasz NR. Increased clinical symptoms of acromegalic arthropathy in patients with long-term disease control: a prospective follow-up study. Pituitary 2014; 17:44-52. [PMID: 23344976 DOI: 10.1007/s11102-013-0464-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Arthropathy is an invalidating complication of acromegaly. This arthropathy deteriorates radiographically despite long-term disease control. However, the clinical course and its relationship to the radiographic course are currently unknown. We aimed to investigate the clinical course of arthropathy during follow-up and its relationship to radiographic progression in long-term controlled acromegaly patients. Prospective follow-up study. We studied 58 patients (mean age 62 years, women 41 %) with controlled acromegaly for a mean of 17.6 years. Clinical progression of joint disease was defined at baseline and after 2.6 years, by the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) and Australian/Canadian Osteoarthritis Index (AUSCAN) questionnaires for lower limb and hand OA, respectively, and performance tests. Potential risk factors for progression were assessed. The clinical course of arthropathy was related to the radiographic course. On average, hand and lower limb function deteriorated during follow-up, despite large interindividual variations. Joint pain was stable over time. High levels of pain and functional impairment at baseline were related to clinical progression of hand pain and functional limitations. High baseline BMI was a risk factor for functional deterioration in the lower limb. The changes in symptoms and radiographic progression during follow-up were not related. In treated acromegaly patients, joint function deteriorates during prolonged follow-up, despite biochemical disease control, although there was interindividual variation. Clinical and radiographic course of arthropathy were not related. Therefore, in clinical practice, a combination of clinical and radiographic assessment is necessary to evaluate the course of acromegalic arthropathy.
Collapse
Affiliation(s)
- K M J A Claessen
- Department of Endocrinology and Metabolic Diseases C4-R and Center for Endocrine Tumors Leiden, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands,
| | | | | | | | | | | | | |
Collapse
|
91
|
|
92
|
Abstract
BACKGROUND Health-related quality of life (QoL) is severely impaired in acromegaly due to the physical and psychological consequences of the disease. Pharmacological and surgical treatments, when available, can improve QoL and life expectancy. CASE DESCRIPTION A 34-year-old male with uncontrolled acromegaly due to a large and invasive macroadenoma, which could not be resected by transsphenoidal surgery. Over 9 years, he had limited access to pharmacological interventions and persisted with clinically and biochemically active disease, with severe co-morbidities and a poor QoL, which eventually lead to a premature sudden death. CONCLUSION This case highlights the impact that active acromegaly has when treatment resources are limited. We review the factors contributing to poor QoL in this disease, with special reference to the Latin American scenario.
Collapse
Affiliation(s)
- Mirtha Guitelman
- División Endocrinología, Hospital Carlos G. Durand, Buenos Aires, Argentina
| | - Alin Abreu
- Endocrinología, Centro Médico Imbanaco, Cali, Colombia
| | | | - Moisés Mercado
- Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
- Endocrine Service, Experimental Endocrinology Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Aristóteles 68 Polanco, 11560 Mexico City, Mexico
| |
Collapse
|
93
|
Geraedts VJ, Dimopoulou C, Auer M, Schopohl J, Stalla GK, Sievers C. Health Outcomes in Acromegaly: Depression and Anxiety are Promising Targets for Improving Reduced Quality of Life. Front Endocrinol (Lausanne) 2014; 5:229. [PMID: 25610427 PMCID: PMC4285111 DOI: 10.3389/fendo.2014.00229] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 12/10/2014] [Indexed: 11/13/2022] Open
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.
Collapse
Affiliation(s)
- Victor Jacobus Geraedts
- Max Planck Institute of Psychiatry, Munich, Germany
- Leiden University Medical Center, Leiden, Netherlands
| | | | | | - Jochen Schopohl
- Medizinische Klinik Innenstadt, Ludwig-Maximilians University, Munich, Germany
| | | | - Caroline Sievers
- Max Planck Institute of Psychiatry, Munich, Germany
- *Correspondence: Caroline Sievers, Department of Endocrinology, Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, Munich 80804, Germany e-mail:
| |
Collapse
|
94
|
Siegel S, Streetz-van der Werf C, Schott JS, Nolte K, Karges W, Kreitschmann-Andermahr I. Diagnostic delay is associated with psychosocial impairment in acromegaly. Pituitary 2013. [PMID: 23179964 DOI: 10.1007/s11102-012-0447-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of this study was to systematically assess health care utilisation, diagnostic delay and psychosocial impairment in patients with acromegaly in rural versus urban health care environments. 41 patients with acromegaly were questioned to time lapse of symptom onset, first seeking medical advice and time of acromegaly diagnosis. Quality of life (QoL), and psychosocial impairment (depression, daytime sleepiness, sleep disturbances, disturbances of body image) were measured by self-assessment questionnaires. Patients were grouped into living in rural health care environments (RHCE, n = 22 patients) or urban health care environments (UHCE, n = 19 patients) using data on population density from the German Federal Statistical Office. RHCE patients waited significantly longer (2.5 vs. 0.89 years; p = .025) after symptom onset before seeking medical advice, but diagnosis of acromegaly was established at least as quickly as in UHCE (1.45 vs. 2.74 years; n.s.). There was a consistent trend toward more psychosocial impairment in UHCE which reached significance for sleep disturbances (p = .004). For all patients significant correlations between time delay of diagnostic process (defined as first visit to the doctor because of acromegaly-related symptoms and establishment of acromegaly diagnosis) and psychological QoL, depression, daytime sleepiness, sleep disorders and body image emerged. Patients with acromegaly in UHCE experienced more psychosocial impairment than patients in RHCE. The correlation of significantly increased psychosocial impairment and delay of diagnosis by the physician may reflect long-lasting embitterment in patients with acromegaly and should be considered during psychosocial counselling.
Collapse
Affiliation(s)
- Sonja Siegel
- Department of Neurosurgery, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | | | | | | | | | | |
Collapse
|
95
|
Giustina A, Karamouzis I, Patelli I, Mazziotti G. Octreotide for acromegaly treatment: a reappraisal. Expert Opin Pharmacother 2013; 14:2433-47. [PMID: 24124691 DOI: 10.1517/14656566.2013.847090] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Acromegaly is a rare disorder characterized by excess secretion of growth hormone (GH) generally caused by a pituitary macroadenoma and associated with reduced life expectancy if the disease is untreated. This article covers the recent available evidences published on octreotide , the first somatostatin analog introduced into clinical practice for the medical treatment of acromegaly. AREAS COVERED This article discusses i) pharmacology of somatostatin and octreotide; ii) biochemical effects of regular octreotide and long-acting repeatable formulation; iii) tumor shrinkage effects of octreotide in acromegaly; iv) impact of octreotide on acromegalic clinical manifestations and chronic complications; v) safety of octreotide and vi) place of octreotide in the guidelines for acromegaly treatment. Full-text articles in the English language were selected from a PubMed search spanning 1984 - 2013, for keywords including 'octreotide,' 'acromegaly,' 'GH,' 'IGF-I,' and 'tumor shrinkage.' Reference lists in selected papers were also used to broaden the search. EXPERT OPINION Octreotide is a mature drug with a consolidated favorable benefit versus risks profile in the treatment of acromegaly.
Collapse
Affiliation(s)
- Andrea Giustina
- University of Brescia, Department of Clinical and Experimental Sciences , Brescia , Italy
| | | | | | | |
Collapse
|
96
|
Abstract
Prolonged overproduction of growth hormone, like insulin-like growth factor-1 hypersecretion leads to acromegaly in adults. This is associated with several co-morbidities and increased mortality. Despite typical clinical features and modern diagnostic tools, it often takes years to diagnose from the onset of the disease. The aims of the treatment are to reduce or control tumour growth, inhibit growth hormone hypersecretion, normalize insulin-like growth factor-1 levels, treat co-morbidities and, therefore, reduce mortality. There are three approaches for therapy: surgery, medical management (dopamine agonists, somatostatin analogues and growth hormone receptor antagonist), and radiotherapy. Efficient therapy of the disease is based on the appropriate multidisciplinary team management. The review provides a summary of medical treatment for acromegaly.
Collapse
Affiliation(s)
- Miklós Góth
- Magyar Honvédség Egészségügyi Központ II. Belgyógyászati Osztály, Endokrinológiai Szakprofil Budapest Podmaniczky u. 111. 1062
| |
Collapse
|
97
|
Health-related quality of life and psychiatric symptoms improve effectively within a short time in patients surgically treated for pituitary tumors--a longitudinal study of 106 patients. Acta Neurochir (Wien) 2013; 155:1637-45; discussion 1645. [PMID: 23836354 DOI: 10.1007/s00701-013-1809-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 06/21/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Reduced health-related quality of life (HRQoL) is a common complaint in patients suffering from pituitary tumors. Although successful tumor treatment has been reported to lead to an improvement in perceived HRQoL, the temporal gradient at which these improvements occur has not been fully addressed. METHODS Using three validated health-related questionnaires (SF-36, SCL-90-R, QLS-H), we assessed HRQoL in 106 adult patients harboring pituitary tumors (mean age 48.0 ± 16.0 years) before as well as 3 and 12 months after initiation of treatment. The AcroQoL questionnaire was additionally applied in acromegalic patients. RESULTS There was a significant improvement in all but one scale (role-physical) of the SF-36 questionnaire and all but two scales (interpersonal sensitivity, paranoid ideation) of the SCL-90-R, the QLS-H score and the AcroQoL subscales within 3 months after surgical treatment. The trend to amelioration continued at the 12 month re-assessment, but did not reach statistical significance. Linear regression analyses revealed that younger age and male gender favor a more distinct improvement of HRQoL after treatment. CONCLUSIONS HRQoL is considerably reduced before treatment for pituitary disease. Improvement is an early postoperative phenomenon and occurs within 3 months after treatment. Men and younger patients are more likely to improve within this time span.
Collapse
|
98
|
Yamada S, Fukuhara N, Nishioka H, Yamaguchi-Okada M, Takeshita A, Takeuchi Y. Scalp hair loss after transsphenoidal adenomectomy in patients with acromegaly. Clin Endocrinol (Oxf) 2013; 79:386-93. [PMID: 22963410 DOI: 10.1111/cen.12040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 07/11/2012] [Accepted: 09/05/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Scalp hair loss is often encountered in clinical practice in Japan after successful surgery for acromegaly. However, this intriguing issue has not been addressed in the literature. The aim of this study was to examine scalp hair loss after surgery for acromegaly. METHODS Postoperative scalp hair loss was surveyed using a mail-back questionnaire given to 511 patients undergoing primary surgery for acromegaly, 484 of whom constitute the patient pool in this study. RESULTS Of the 484 patients, 263 (54%) patients noticed varying degrees of hair loss between 3 and 6 months after surgery [the degree of alopecia was minimal in 50 patients (10%), moderate in 117 patients (24%), and severe in 96 patients (20%)], although postoperative hair loss was noticed only in six (3·6%) of 167 patients with nonfunctioning adenomas. Postoperative hair loss was significantly more common in female patients, cured patients and patients with severe postoperative growth hormone deficiency. Among those 263 patients, full recovery was reported by 85 patients (32%), incomplete recovery by 88 patients (34%), and hardly any recovery by 90 patients (34%). A lack of hair recovery was significantly more common in male patients or in patients with severe hair loss after surgery. CONCLUSIONS This, the first large-scale, single-centre, clinical study to shed light on the issue of postoperative hair loss after surgery for acromegaly, shows that it is important to prospectively inform patients that varying degrees of hair loss occur in a large number of acromegalic patients, especially after successful surgery.
Collapse
Affiliation(s)
- Shozo Yamada
- Department of Hypothalamic & Pituitary Surgery, Toranomon Hospital, Tokyo, Japan.
| | | | | | | | | | | |
Collapse
|
99
|
Abstract
AIM The aim of the study was to assess the quality of life and depression status in female patients with acromegaly. PATIENTS AND METHODS Fifty-seven female patients with acromegaly (21 inactive, 36 active) who were being followed-up at the Cerrahpasa Medical School, Endocrinology and Metabolism out-patient clinic, were included in the study. Depression status and quality of life of the patients were evaluated according to disease activity using the Beck Depression Inventory (BDI) and the Acromegaly Quality of Life (AcroQoL) Questionnaire. Prolactin, luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol (E2), total and free testosterone, dehydroepiandrosterone sulfate (DHEA-SO4), 17α-hydroxyprogesterone, androstenedione, free thyroxin (FT4), thyrotropin (TSH), cortisol, GH and IGF-I were studied in the groups. RESULTS The AcroQoL total score in female patients with controlled acromegaly and uncontrolled acromegaly were 45.5 [Interquartile range (IQR)= 32.9-57.4], 47.7 [(IQR)= 38.6-63.3], respectively (p=0.53). There was no difference in BDI scores in acromegalic patients according to disease activity (p=0.41). In the correlation analysis, a strong negative correlation was found between AcroQoL total score and BDI score (r=-0.72, p<0.0001), OSAS (r=-0.32, p=0.01). CONCLUSION This study showed that QoL was impaired in female patients with acromegaly even if they were in remission. Depressive mood and obstructive sleep apnea syndrome (OSAS) could affect QoL in female patients with acromegaly.
Collapse
Affiliation(s)
- O Celik
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, University of Istanbul, Istanbul, Turkey
| | | |
Collapse
|
100
|
van Hulsteijn LT, Louisse A, Havekes B, Kaptein AA, Jansen JC, Hes FJ, Smit JWA, Corssmit EPM. Quality of life is decreased in patients with paragangliomas. Eur J Endocrinol 2013; 168:689-97. [PMID: 23392211 DOI: 10.1530/eje-12-0968] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
CONTEXT Germline mutations in succinate dehydrogenase (SDH) genes predispose carriers for developing paragangliomas, and studies on their quality of life (QoL) are scarce. OBJECTIVES The objectives of this study were to assess QoL in patients with paragangliomas (PGL), to evaluate long-term QoL, and to explore potential differences in QoL between SDH mutation carriers and paraganglioma patients without an SDH mutation. DESIGN Cross-sectional, case-control study. SETTING Tertiary referral center. SUBJECTS ONE HUNDRED AND SEVENTY FOUR PARAGANGLIOMA PATIENTS WERE INCLUDED: 25 SDHB, two SDHC, and 122 SDHD mutation carriers and 25 patients without an SDH mutation. They provided 100 peers as control persons. Furthermore, patients were compared with age-adjusted reference populations. MAIN OUTCOME MEASURES QOL WAS ASSESSED USING THREE VALIDATED HEALTH-RELATED QOL QUESTIONNAIRES: the Hospital Anxiety and Depression Scale, the Multidimensional Fatigue Index 20, and the Short Form 36. RESULTS Patients reported a significantly impaired QoL compared with their own controls, mainly on fatigue and physical condition subscales. Compared with age-adjusted literature values, patients had significantly impaired scores on physical, psychological, and social subscales. A decreased QoL was mainly related to paraganglioma-associated complaints. There was no difference in QoL between the various SDH mutation carriers or paraganglioma patients without an SDH mutation. QoL in asymptomatic mutation carriers, i.e. without manifest disease, did not differ from QoL of the general population. Long-term results in 41 patients showed no alteration in QoL besides a reduced level of activity. CONCLUSION QoL is decreased in paraganglioma patients but stable when measured over time.
Collapse
Affiliation(s)
- L T van Hulsteijn
- Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|