What is the effect of peripheral muscle fatigue, pulmonary function, and body composition on functional exercise capacity in acromegalic patients?

Body Composition, Sarcopenia, and Serum Myokines in Acromegaly: A Narrative Review

Patients with active acromegaly have a higher percentage of lean body mass, a lower percentage of fat body mass, and an increase in their extracellular water compartment compared to healthy individuals. However, muscle function appears to be compromised in patients with acromegaly, with some experiencing worsened physical performance and sarcopenia. Myokine alterations, insulin resistance, dysregulation of protein metabolism, muscle oxidative stress, neuromuscular junction impairment, and increased ectopic intramuscular fat deposits may play roles in muscle dysfunction in patients with acromegaly.

The Glittre Activities of Daily Living Test in patients with acromegaly: Associations with hand function and health-related quality of life

BACKGROUND

Musculoskeletal disorders in acromegaly compromise upper and lower limb activity. Corresponding changes can be better assessed by a functional capacity test incorporating multitasking, such as the Glittre Activities of Daily Living Test (GA-T).

OBJECTIVES

To evaluate functional capacity in adults with acromegaly using the GA-T and to correlate functional capacity with hand function and health-related quality of life.

METHODS

The GA-T was applied to 36 patients with acromegaly and an equal number of healthy individuals. Additionally, participants completed the Acromegaly Quality of Life (AcroQoL) questionnaire and underwent a chronic pain assessment using a map of the human body, a hand function evaluation using the Cochin Hand Functional Scale (CHFS), and a handgrip strength test.

RESULTS

Relative to the comparison group, patients with acromegaly required more time to perform the GA-T, showed worse hand function, and reported that squatting to accomplish shelving tasks was the major difficulty. GA-T time was correlated with the AcroQoL global score, handgrip strength, and the CHFS (rs=-0.487, p= 0.002; rs=-0.369, p= 0.026; rs= 0.538, p= 0.0007, respectively).

CONCLUSIONS

Patients with acromegaly exhibited a reduced functional capacity as assessed by the GA-T. Additionally, an association was identified between the total GA-T time and both hand function and quality of life.

The evaluation of the tendon and muscle changes of lower extremity in patients with acromegaly

PURPOSE

Although it is well known that acromegaly causes enlargement in the extremities, studies investigating the effects of acromegaly on tendons, muscles and soft tissue are limited. The aims of our study were to investigate tendons, the presence of enthesitis, soft tissue, muscle groups in terms of thickness and pennation angle (PA) which is an indicator of microstructure and strength of the muscle, of the lower extremities.

METHODS

Thirty-nine patients with acromegaly and thirty-nine healthy control subjects similar for age, sex and body mass index were enrolled. Lower extremity tendons, skin, muscle groups were evaluated by ultrasound.

RESULTS

The thicknesses of heel skin, heel pad, plantar fascia and Achilles tendon were higher in acromegaly than the control group (p < 0.05). The incidence of Achilles enthesitis were increased in the acromegaly group (p < 0.05). The thicknesses of the gastrocnemius medial head, vastus medialis, lateralis muscles for both sides and the left rectus femoris muscle were found to be lower in the acromegaly patients than controls (p < 0.05). However, thicknesses of vastus intermedius, gastrocnemius lateral head and soleus were similar between the acromegaly and control groups (p > 0.05). PA values of the right and left vastus medialis and the right vastus lateralis were found to be decreased in the acromegaly group (p < 0.05). Myostatin levels were lower in acromegaly group (p < 0.05).

CONCLUSIONS

Acromegaly may cause to an increase in tendon and soft tissue thickness, enthesitis formation, decrease in the thickness of some muscles, and deterioration in microstructures in lower extremity.

The impact of functional exercise on the reversal of acromegaly induced frailty: a case report

BACKGROUND

Acromegaly is an endocrine disease caused by the excess secretion of growth hormone and is responsible for the development of multiple comorbidities that can reduce physiologic reserve. The hypersecretion of growth hormone (GH) affects virtually every organ in the body and can predispose an individual to frailty; a state of vulnerability resulting from cumulative decline across multiple systems. Frailty results in a loss of physiologic reserve and vulnerability to adverse outcomes such as morbidity and mortality. Case Description: The patient was a 73-year-old male with acromegaly who declined into a cycle of frailty following coronary artery bypass graft (CABG) and aortic valve replacement surgery. Prolonged hospitalization and lack of adequate physical stress led to the depletion of reserve in the cardiopulmonary, cognitive, musculoskeletal, and neuromuscular systems, leaving a previously independent adult fully dependent for mobility. Outcomes: The patient participated in a twelve-week multicomponent physical therapy program in a skilled nursing facility. The exercise program was designed and administered to impact multiple systems and provide the necessary overload for adaptation. The patient demonstrated significant improvement in the Berg Balance Scale (BBS), Tinetti (POMA), Functional Outcome Scale (FOS), and returned to independent community ambulation.. Discussion: The case illustrates the effectiveness of a multicomponent functional-based exercise program to improve markers of frailty and reverse functional decline in a frail older adult with acromegaly.

Lower limb muscle fatigability is not associated with changes in movement strategies for balance control in the upright stance

BACKGROUND

Fatigue is a distressing symptom inversely related to postural stability in adults with neuromuscular and systemic diseases. However, there is no information about the effects of lower limb muscles fatigability on the movement strategies for balance control in the upright standing.

METHODS

This study enrolled 41 healthy subjects (female/male: 22/19; age 23 ± 3 years; body mass index 25.4 ± 3.7 kg/m²). Participants underwent posturography and surface electromyography of the gastrocnemius medialis muscle during a sustained, fatiguing voluntary contraction of the gastrocnemius preceded and followed by quiet standing (120 s). Amplitude of electromyograms and fatigability were evaluated using the root mean square (RMS) value and both the RMS and spectral median frequency (f_med) slopes. Balance control was evaluated using the center-of-pressure elliptic area (Area) and average velocity (Vavg). Movement strategies for balance control were evaluated using the number of high-density regions (nHDR) and spatial patterns of the three-dimensional statokinesigram.

RESULTS

Mean time to muscle fatigability was 258 ± 190 s. Area and Vavg but not nHDR increased after the fatiguing task. Single-centered spatial patterns were predominant in both tasks (pre-fatigue: n = 22/41; post-fatigue: n = 19/41), with no evidence of an association between the spatial patterns and tasks (γ = 0.237, 95%CI = [-0.338; 0.542]).

CONCLUSIONS

Lower limb muscle fatigability increases postural instability, but it is not associated with changes in movement strategies for balance control in the upright stance.

Physical exercise improves functional capacity and quality of life in patients with acromegaly: a 12-week follow-up study

OBJECTIVE

Although the focus of acromegaly treatment is the hormonal control of the disease, a new perspective must be given to the functional rehabilitation of these patients, especially when considering the recent increase in survival. The aim of this study was to evaluate the effects of therapist-oriented home rehabilitation (TOHR) on patients with acromegaly.

PATIENTS AND METHODS

Seventeen adults with acromegaly followed an exercise programme from a booklet with instructions for each exercise prescribed, for 2 months, and were reassessed after 1 month of washout. At each of the 3 timepoints (before and after the intervention and at the 1-month follow-up), the participants were subjected to the following assessments: body composition through bioimpedance, health-related quality of life (HRQoL) using the Acromegaly Quality of Life (AcroQoL) questionnaire, general fatigue through the Functional Assessment of Chronic Illness Therapy-Fatigue scale, handgrip strength, lower extremity functionality using isometric dynamometry and the Lower Extremity Functional Scale (LEFS), body balance through stabilometry, and functional capacity through 6-minute walking distance (6MWD).

RESULTS

After performing TOHR, improvements in general fatigue, quadriceps muscle strength, LEFS, 6MWD, balance control and all AcroQoL dimensions were observed (all P < 0.05). After 1 month of washout, however, these gains were lost for all parameters, except the LEFS and balance control.

CONCLUSIONS

In acromegaly, TOHR results in improvements in muscle function, functional capacity, general fatigue, body balance, and HRQoL. Large randomized controlled trials are needed to replicate these benefits and to recommend rehabilitation, especially for those with long-term illness.

Clinical and functional variables can predict general fatigue in patients with acromegaly: an explanatory model approach

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 (IR1,2); 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 R2 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, PWV, AC, IR1,2, DYN, and the distance in the 6MWT were 49.4 ± 11.2 years, 31.2 ± 18.9 score, 10.19 ± 2.34 m/s, 1.08 ± 0.46 x106 cm5/din, 85.3 ± 29.7%, 33.9 ± 9.3 kgf, and 603.0 ± 106.1 m, respectively. The best predictive model (R2 = 0.378, R2 adjusted = 0.280, standard error = 16.1, and P = 0.026) comprised the following regression equation: MFIS = 48.85 - (7.913 × IGF-I) + (1.483 × AC) - (23.281 × DYN).

CONCLUSION

Hormonal, vascular, and functional variables can predict general fatigue in patients with acromegaly.

Systemic Complications of Acromegaly and the Impact of the Current Treatment Landscape: An Update

Acromegaly is a chronic systemic disease with many complications and is associated with increased mortality when not adequately treated. Substantial advances in acromegaly treatment, as well as in the treatment of many of its complications, mainly diabetes mellitus, heart failure, and arterial hypertension, were achieved in the last decades. These developments allowed change in both prevalence and severity of some acromegaly complications and furthermore resulted in a reduction of mortality. Currently, mortality seems to be similar to the general population in adequately treated patients with acromegaly. In this review, we update the knowledge in complications of acromegaly and detail the effects of different acromegaly treatment options on these complications. Incidence of mortality, its correlation with GH (cumulative exposure vs last value), and IGF-I levels and the shift in the main cause of mortality in patients with acromegaly are also addressed.

The effectiveness of a therapist-oriented home rehabilitation program for a patient with acromegaly: A case study

BACKGROUND

Acromegaly causes numerous functional limitations that negatively impact patients' performance of activities of daily living (ADLs) and contribute to the deterioration of health-related quality of life (HRQoL). Thus, the purpose of the present case study was to evaluate the effect of therapist-oriented home rehabilitation (TOHR) for a patient with acromegaly.

CASE DESCRIPTION

We report the case of a 53-year-old man who was diagnosed with primary acromegaly 17 years ago. He complained of difficulties performing tasks that involved his hands, pain in the lower limbs, and fatigue when he climbed a few flights of stairs. Although he performed ADLs independently, he reported some difficulties or discomfort when performing them.

INTERVENTION AND OUTCOME

The patient underwent a booklet-guided physical exercise program that lasted two months (three times per week, 60 minutes per session). The activities included overall stretching, muscle strengthening, and endurance exercises, along with aerobic conditioning through functional circuit training. After two months of exercise, he reported improved HRQoL as assessed with the Acromegaly Quality of Life Questionnaire, with increases in quadriceps muscle strength and 6-min walking distance. However, none of these benefits remained when the patient was assessed after a 1-month washout period.

CONCLUSION

This study showed that patients with acromegaly may benefit markedly from TOHR, which could provide a novel therapeutic approach as an adjunct to hormone control therapy.

Diagnosis, treatment and clinical perspectives of acromegaly

Acromegaly is an insidious disease of the pituitary caused by a growth hormone-secreting adenoma. Generally, the diagnosis is made rather late in the course of the disease. Currently, acromegaly can be cured in about half of the patients with the disease by expert surgery. The remainder of non-surgically cured patients often can be effectively treated with somatostatin analogs; either with the new generation of dopaminergic drugs or with Pegvisomant, a GH-receptor blocking agent. However, at the time of diagnosis many patients suffer from serious comorbidities, including hypertension, heart disease, arthrosis, sleep apnea and diabetes mellitus. Recent reports have shown that mortality risk can be normalized. Nevertheless, all efforts should be undertaken to treat comorbidities. New strategies for surgery and medical treatment are discussed.