On the Functional Capacity and Quality of Life of Patients with Acromegaly: Are They Candidates for Rehabilitation Programs? (original) (raw)
Pituitary, 2021
Purpose There is no consensus on quality of life (QOL) in patients with acromegaly requiring medical treatment after surgery compared with those achieving remission by surgery alone. Methods QuaLAT is a cross-sectional study comparing QOL in surgery-only treated acromegaly patients versus those requiring medical treatment post-surgery. Patients attending clinics were identified and divided into—Group 1: patients who had surgery only and were in biochemical remission, Group 2: all patients on medical treatment post-surgery, Group 3: patients from Group 2 with biochemical control. Participants were asked to fill three questionnaires; Acromegaly Quality of Life Questionnaire (ACROQOL), 36-Item Short Form Survey (SF36), and Fatigue Severity Scale (FSS). Results There were 32 patients in Group 1 and 25 in Group 2. There was no difference in QOL scores between groups 1 and 2, as measured by ACROQOL (mean difference [MD] = − 2.5, 95% CI − 16.6 to 11.6; p = 0.72), SF36v2 [Physical component...
Impact of exercise on quality of life and body-self perception of patients with acromegaly
Pituitary, 2013
In acromegaly the impact of therapy on wellbeing 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 healthrelated 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.
Posture and balance control in patients with acromegaly: Results of a cross-sectional study
Gait & Posture, 2014
Acromegaly is a chronic debilitating disease that presents with multiple systemic manifestations, including changes in body composition, joint abnormalities, muscular impairment and visual disturbances. This study aimed to assess posture and body balance in acromegalic patients and to establish the correlation between these measures. Twenty-eight acromegalic patients and a similar number of control subjects matched for sex, age, weight, height and body mass index underwent postural evaluation using the photogrammetry and measurement of balance using the stabilometry in two tasks: feet apart, eyes open and feet together, eyes closed. In comparison with the control group, the acromegalic group presented postural deviations in lateral views in the vertical alignment of the trunk (P = 0.001 for the right side and P = 0.021 for the left), the hip angle (P = 0001 for the right side and P = 0.016 for the left side) and horizontal alignment of the pelvis (P = 0.017 for the right and P < 0.001 for the left side). Compared with healthy subjects, the acromegalic patients presented displacement of the centre of pressure in both the anterior-posterior direction and the medial-lateral direction in both evaluated tasks. We observed significant correlations between balance measures and the following posture evaluation variables: distance between the lower limbs, horizontal alignment of the head and vertical alignment of the head. Our results suggest that posture and balance need to be evaluated for acromegalic patients in clinical practice, as there are significant postural imbalances and deviations in these patients.
Archives of Endocrinology and Metabolism
Objective: To evaluate whether hormonal profile, arterial function, and physical capacity are predictors of fatigue in patients with acromegaly. Subjects and methods: This is a cross-sectional study including 23 patients. The subjects underwent a Modified Fatigue Impact Scale (MFIS) assessment; serum growth hormones (GH) and IGF-1 measurements; pulse wave analysis comprising pulse wave velocity (PWV), arterial compliance (AC), and the reflection index (IR 1,2); dominant upper limb dynamometry (DYN); and the six-minute walking distance test (6MWT). Multiple linear regression models were used to identify predictors for MFIS. The coefficient of determination R 2 was used to assess the quality of the models' fit. The best model was further analyzed using a calibration plot and a limits of agreement (LOA) plot. Results: The mean ± SD values for the participants' age, MFIS,
Impact of musculoskeletal disease on quality of life in long-standing acromegaly
European Journal of Endocrinology, 2008
Objective: To provide rheumatological assessment of patients with long-standing acromegaly and investigate the impact of musculoskeletal disease on quality of life. Design: Cross-sectional observational study. Methods: Fifty-eight patients diagnosed with acromegaly at least 5 years previously were interviewed and examined by a rheumatologist. Each patient completed the short form-36 (SF-36), arthritis impact measurement scales 2 (AIMS2) and acromegaly quality of
Static and dynamic balances of patients with acromegaly and impact of exercise on balance
Pituitary, 2019
Purpose Patients with acromegaly may have balance abnormalities due to changes in body composition. We aim to compare static and dynamic balances in patients with acromegaly and healthy volunteers, and to evaluate the effects of exercise on balance in patients with acromegaly. Methods This prospective study included 25 patients with acromegaly followed at endocrinology clinic of Cerrahpasa Medical Faculty and 13 healthy volunteers. The acromegalic patients were divided into 2 groups. Group A (n = 11) attended an exercise program 3 days/week for 3 months, whereas group B (n = 14) and healthy volunteers (Group C) were exercise-free. Bipedal and unipedal stance static and dynamic balance tests were performed using a Prokin 252N device. Results The ages, demographic characteristics, and body compositions were similar. In acromegalic patients, the static balance parameters of displacement of center-of-pressure in anterior-posterior direction (C.o.P.Y) while eyes open (p = 0.002) and on left leg (p = 0.001), in left-right direction (C.o.P.X) on right leg (p = 0.03), eyes-closed average medio-lateral velocity (AMLV) (p = 0.001) and the dynamic parameter of forward/backward front/right standard deviation (FBFRSD) (p = 0.02) were significantly different from healthy controls. When the exercise effect on balance was evaluated between group A and B, there were significant improvements in most parameters of dynamic balance measurements of both forward-backward and medial-lateral sway (FBFRSD, FBDME, and RLBLSD) (p = 0.02, p = 0.02, and p = 0.004, respectively) after exercise in group A. Conclusions Patients with acromegaly had impairments at various static and dynamic balance parameters, especially in posterior direction. After a 3-month exercise program, the dynamic balance profoundly improved, but static balance was relatively preserved in patients with acromegaly.
Predictors of Quality of Life in Acromegaly: No Consensus on Biochemical Parameters
Frontiers in Endocrinology, 2017
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 2 Geraedts et al.
Journal of Physical Therapy Science, 2015
The six-minute walk test (6MWT) is increasingly being used as an important tool for analyzing functional capacity in patients with multisystem disorders. The aim of this study was to evaluate the effect of body composition, peripheral muscle function, and pulmonary function on the six-minute walk distance (6MWD) in acromegalic patients. [Subjects and Methods] Thirty-two patients with active acromegaly, with a mean age of 48.6 ± 12.1 years, underwent an evaluation of body composition using electrical bioimpedance, isometric dynamometry with surface electromyography, tests of pulmonary function, and the 6MWT. [Results] The mean ± SD values for the 6MWD, fat-free mass (FFM), and maximal expiratory pressure (MEP) were 65.5 ± 11.7% predicted, 55.1 ± 10.6 kg, and 55.2 ± 16.8% predicted, respectively. There was a significant correlation between the 6MWD and the following parameters: the angle of the linear regression line obtained using the values of the median frequency electromyography signal over time during the fatigability test for the vastus medialis muscle (MDF, r=0.65), FFM (r=0.62), MEP (r=0.60), height (2) /resistance index (r=0.52), resistance (r=−0.50), and forced expiratory volume in 1 second (r=0.50). Multivariate analysis showed that MDF, FFM, and MEP were independent predictors of the 6MWD (R 2 =0.52). [Conclusion] The fatigability of the peripheral muscles, FFM, and MEP are the primary determinants of the 6MWD in acromegalics.
The impact of biochemical control on the quality of life of patients with acromegaly
BULLETIN OF INTEGRATIVE PSYCHIATRY
Purpose: Quality of life (Qol) is undoubtedly important for patient case management. The current goal of a treatment extends therefore beyond biochemical monitoring, including the physical, mental and social state of wellbeing. We aimed to correlate disease activity with the perception of Qol in acromegalic patients. Methods: We performed a single center cross-sectional study on 26 patients: 9 men (34.6%) and 17 women (65.4%), with a mean age of 53 ± 11.5 years. Eleven patients (42.3%) had a biochemically controlled disease, while 15 subjects (57.7%) had an active disease. Results: The mean total score of the quality of life was 60.9 ± 12.6 in women, ranging from 40 to 85, while for men, the mean total score was of 64.04 ± 14.78, ranging from 42 to 85 (p=0.575). There was no significant difference between the mean AcroQol scores of patients with controlled or active disease (62.54 ± 13.42 vs 61.23 ± 13.46, p = 0.804). Patients younger than 60 had a significantly lower total score compared to older patients, (58.36 ± 14.17 vs 64.26 ± 12.44, p=0.047). Rural residents also scored lower than patients belonging to the urban region: (58.18 ± 11.21 vs 67.19 ± 14.39, p=0.048). Disease duration was negatively correlated with total score on AcroQol (r =-0.253, p= 0.045). We did not find significant correlations between GH and IGF1 levels and AcroQol (p=0,622 and p = 0.844, respectively). Conclusions: We found no significant differences between males and females, as well as between patients with active and controlled disease regarding the Qol, but other factors like 72/Bulletin of Integrative Psychiatry New Series December 2019 Year XXV No. 4 (83) age or locality provenience may play some role for the perceived health status and quality of life in acromegalic patients