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Fajardo C, Álvarez-Escola C, Biagetti B, Garcia-Centeno R, Ciriza R, Sánchez-Cenizo L, Díaz-Muñoz M. Preference of acromegaly patients for treatment attributes in Spain. Endocrine 2023; 82:379-389. [PMID: 37507554 PMCID: PMC10543785 DOI: 10.1007/s12020-023-03462-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVE Acromegaly is a rare disease caused by increased growth hormone secretion and a subsequent increase in insulin-like growth factor I (IGF-I) levels. Patients display multiple comorbidities that affect their quality of life (QoL). Treatment aims to maintain good biochemical control, tumour control and reduce the risk of comorbidities; however, their impact on QoL has been overlooked until recently. We interviewed patients to explore their preferences with regard to treatment attributes. DESIGN A cross-sectional study based on interviews and a discrete choice experiment (DCE) in a Spanish cohort. METHODS Adult patients diagnosed with acromegaly ≥1 year before the start of the study and under treatment were included. Treatment attributes were collected from patient testimony during face-to-face interviews. Then, a DCE was performed to elicit patient preferences for certain treatment attributes. RESULTS Sixty-seven patients completed the study. QoL improvement was the most important treatment attribute (37%), followed by IGF-I control (20%), blood sugar control (17%) and tumour control (13%). Secondary attributes were pain associated with the route of administration (7%), diarrhoea (2%), administration method (2%) and storage conditions (2%). We then calculated the theoretical share of preference for existing treatments, based on the individual preference utility for each attribute and level. Pegvisomant obtained the highest share of preference overall, and the highest preference as a second-line treatment (53 and 95%, respectively). CONCLUSIONS QoL greatly influences patient treatment preference. Since acromegaly patients are informed and aware of their disease, treatment choices should always be shared with patients.
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Affiliation(s)
- Carmen Fajardo
- Endocrinology Department, La Ribera University Hospital, Alzira, Valencia, Spain
| | | | - Betina Biagetti
- Diabetes and Metabolism Research Unit, Vall d'Hebron University Hospital and Vall d'Hebron Research Institute (VHIR), Universidad Autónoma de Barcelona, Barcelona, Spain
| | | | - Raquel Ciriza
- Spanish Association of People Affected by Acromegaly (Asociación de pacientes Afectados por Acromegalia), Huesca, Spain
| | | | - Marcos Díaz-Muñoz
- Medical Affairs Department, Pfizer S.L.U, Alcobendas, Madrid, Spain.
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2
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Hageman IC, van Rooij IALM, de Blaauw I, Trajanovska M, King SK. A systematic overview of rare disease patient registries: challenges in design, quality management, and maintenance. Orphanet J Rare Dis 2023; 18:106. [PMID: 37147718 PMCID: PMC10163740 DOI: 10.1186/s13023-023-02719-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 05/01/2023] [Indexed: 05/07/2023] Open
Abstract
Patient registries serve to overcome the research limitations inherent in the study of rare diseases, where patient numbers are typically small. Despite the value of real-world data collected through registries, adequate design and maintenance are integral to data quality. We aimed to describe an overview of the challenges in design, quality management, and maintenance of rare disease registries.A systematic search of English articles was conducted in PubMed, Ovid Medline/Embase, and Cochrane Library. Search terms included "rare diseases, patient registries, common data elements, quality, hospital information systems, and datasets". Inclusion criteria were any manuscript type focused upon rare disease patient registries describing design, quality monitoring or maintenance. Biobanks and drug surveillances were excluded.A total of 37 articles, published between 2001 and 2021, met the inclusion criteria. Patient registries covered a wide range of disease areas and covered multiple geographical locations, with a predisposition for Europe. Most articles were methodological reports and described the design and setup of a registry. Most registries recruited clinical patients (92%) with informed consent (81%) and protected the collected data (76%). Whilst the majority (57%) collected patient-reported outcome measures, only few (38%) consulted PAGs during the registry design process. Few reports described details regarding quality management (51%) and maintenance (46%).Rare disease patient registries are valuable for research and evaluation of clinical care, and an increasing number have emerged. However, registries need to be continuously evaluated for data quality and long-term sustainability to remain relevant for future use.
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Affiliation(s)
- Isabel C Hageman
- Department for Surgery, Pediatric Surgery, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands.
- Surgical Research, Murdoch Children's Research Institute, Melbourne, Australia.
| | - Iris A L M van Rooij
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ivo de Blaauw
- Department for Surgery, Pediatric Surgery, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Misel Trajanovska
- Surgical Research, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Sebastian K King
- Surgical Research, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
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van Trigt VR, Pelsma ICM, Biermasz NR. Patient-reported outcomes in refractory hormone-producing pituitary adenomas: an unmet need. Pituitary 2023:10.1007/s11102-023-01309-4. [PMID: 37014498 DOI: 10.1007/s11102-023-01309-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2023] [Indexed: 04/05/2023]
Abstract
PURPOSE To describe quality and outcomes of patient-reported outcome (PRO) measures (PROMs) used in patients with refractory hormone-producing pituitary adenomas, and to provide an overview of PROs in these challenging pituitary adenomas. METHODS Three databases were searched for studies reporting on refractory pituitary adenomas. For the purpose of this review, refractory adenomas were defined as tumors resistant to primary therapy. General risk of bias was assessed using a component approach and the quality of PROM reporting was assessed using the International Society for Quality of Life Research (ISOQOL) criteria. RESULTS 20 studies reported on PROMs in refractory pituitary adenomas, using 14 different PROMs, of which 4 were disease specific (median general risk of bias score: 33.5% (range 6-50%) and ISOQOL score: 46% (range 29-62%)). SF-36/RAND-36 and AcroQoL were most frequently used. Health-related quality of life in refractory patients (measured by AcroQoL, SF-36/Rand-36, Tuebingen CD-25, and EQ-5D-5L) varied greatly across studies, and was not always impaired compared to patients in remission. CONCLUSION There is a scarcity of data on PROs in the subset of pituitary adenomas that is more difficult to treat, e.g., refractory and these patients are difficult to isolate from the total cohort. The patients' perspective on quality of life, therefore, remains largely unknown in refractory patients. Thus, PROs in refractory pituitary adenomas require adequate analysis using properly reported disease specific PROMs in large cohorts to enable appropriate interpretation for use in clinical practice.
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Affiliation(s)
- Victoria R van Trigt
- Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors Leiden, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Iris C M Pelsma
- Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors Leiden, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Nienke R Biermasz
- Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors Leiden, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
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4
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Dal J, Rosendal C, Karmisholt J, Feldt-Rasmussen U, Andersen MS, Klose M, Feltoft C, Heck A, Nielsen EH, Jørgensen JOL. Sex difference in patients with controlled acromegaly-A multicentre survey. Clin Endocrinol (Oxf) 2023; 98:74-81. [PMID: 35474467 PMCID: PMC10083986 DOI: 10.1111/cen.14750] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/03/2022] [Accepted: 04/08/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Active acromegaly is subject to sex differences in growth hormone (GH) and Insulin like growth factor 1 (IGF-I) patterns as well as clinical features but whether this also pertains to controlled disease is unclear. DESIGN In a cross-sectional, multi-centre study, 84 patients with acromegaly (F = 43, M = 41), who were considered controlled after surgery alone (n = 23) or during continued somatostatin receptor ligand (SRL) treatment (n = 61), were examined. METHODS Serum concentrations of GH, insulin, glucose and free fatty acid (FFA) were measured during an oral glucose tolerance test (OGTT) together with baseline serum IGF-I and completion of two HR-Qol questionnaires (acromegaly quality of life questionnaire [AcroQol] and Patient-assessed Acromegaly Symptom Questionnaire [PASQ]). RESULTS The mean age at the time of the study was 57 (±1.1) years and the majority of females (were postmenopausal. Females had significantly higher fasting GH but comparable IGF-I standard deviation scores (SDS). Using fasting GH < 1.0 µg/L as cut off, disease control was less prevalent in females (F: 56% vs. M: 83%, p = .007) whereas a comparable figure was observed using IGF-I SDS < 2 (F:79% vs. M:76%, p = .71). Compared with males, female patients showed impaired AcroQol physical score (p = .05), higher fasting FFA (p = .03) and insulin concentrations during the OGTT (p = .04). CONCLUSION In patients with acromegaly considered controlled, postmenopausal females exhibited higher GH levels than males despite comparable IGF-I levels, which also translated into impaired metabolic health and well-being. Our findings point to the relevance of including GH measurements in the assessment of disease control and suggest that disease-specific sex differences prevail after treatment.
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Affiliation(s)
- Jakob Dal
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Centre North Jutland, Aalborg, Denmark
| | - Christian Rosendal
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Jesper Karmisholt
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Endocrinology and Metabolism, National University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | | | - Marianne Klose
- Department of Endocrinology and Metabolism, National University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Claus Feltoft
- Department of Endocrinology, Herlev University Hospital, Herlev, Denmark
| | - Ansgar Heck
- Section of Specialized Endocrinology, Oslo University Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Eigil H Nielsen
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Jens O L Jørgensen
- Department of Endocrinology, Aarhus University Hospital, Aarhus C, Denmark
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Castle-Kirszbaum M, Wang YY, King J, Kam J, Shi MDY, Goldschlager T. Validation of the anterior skull base questionnaire 35 in endoscopic pituitary adenoma surgery. Neurosurg Rev 2022; 46:7. [PMID: 36482220 DOI: 10.1007/s10143-022-01921-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 11/14/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022]
Abstract
Patient quality of life (QOL) is an important metric of surgical success. To guide therapeutic advances in pituitary adenoma surgery, a validated, comprehensive instrument to quantify QOL is required. We aim to evaluate the validity of the 35 item anterior skull base questionnaire (ASBQ-35) in patients undergoing pituitary adenoma surgery. A total of 168 patients undergoing endoscopic resection of pituitary adenomas underwent longitudinal QOL assessment using the ASBQ-35 and the 22-item Sinonasal Outcomes Test (SNOT-22) over the first postoperative year. Validity of the ASBQ-35 was assessed by internal consistency, test-retest reliability, responsiveness to clinical change, and concurrent validity with the SNOT-22. Internal consistency of the ASBQ-35 was excellent, with a Cronbach's alpha > 0.95 across all timepoints. Test-retest reliability between 3 and 6 months (ICC = 0.82, p < 0.001) and 6 months and 12 months (ICC = 0.78, p < 0.001) was robust. Concurrent validity with SNOT-22 was strong across all timepoints (absolute Pearson r ≥ 0.63, p < 0.001). Mean ASBQ-35 scores were significantly worse at 3 weeks compared to preoperative baseline (mean difference - 0.28, p < 0.01); however, by 12 months, scores had significantly improved (mean difference + 0.24, p < 0.01), indicating that the scale is responsive to clinical change. Each of the 6 domains of the ASBQ, and all 35 component questions, contributed to the discriminative of the ASBQ to measure QOL during the first postoperative year. The ASBQ-35 is a valid, comprehensive tool for assessing QOL after endoscopic pituitary adenoma surgery. Each component of the ASBQ-35 contributed to the overall assessment of QOL during the first postoperative year.
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Affiliation(s)
- Mendel Castle-Kirszbaum
- Department of Neurosurgery, Monash Health, 246 Clayton Road, Clayton VIC 3168, Melbourne, Australia.
- Department of Surgery, Monash University, Melbourne, Australia.
| | - Yi Yuen Wang
- Department of Neurosurgery, St Vincent's Health, Melbourne, Australia
| | - James King
- Department of Neurosurgery, Royal Melbourne Hospital, Melbourne, Australia
| | - Jeremy Kam
- Department of Neurosurgery, Monash Health, 246 Clayton Road, Clayton VIC 3168, Melbourne, Australia
- Department of Neurosurgery, Royal Melbourne Hospital, Melbourne, Australia
| | | | - Tony Goldschlager
- Department of Neurosurgery, Monash Health, 246 Clayton Road, Clayton VIC 3168, Melbourne, Australia
- Department of Surgery, Monash University, Melbourne, Australia
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Rusenova Y, Vandeva S, Elenkova A, Petrova G, Kamusheva M. Quality of life of patients with acromegaly: comparison of different therapeutic modalities. Expert Opin Orphan Drugs 2022. [DOI: 10.1080/21678707.2022.2153670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Yanitsa Rusenova
- Department of Organization and Economics of Pharmacy, Medical University-Sofia, Sofia, Bulgaria
| | - Silvia Vandeva
- Department of Endocrinology, USHATE “Acad. Ivan Penchev,” Medical University–Sofia, Sofia, Bulgaria
| | - Atanaska Elenkova
- Department of Endocrinology, USHATE “Acad. Ivan Penchev,” Medical University–Sofia, Sofia, Bulgaria
| | - Guenka Petrova
- Department of Organization and Economics of Pharmacy, Medical University-Sofia, Sofia, Bulgaria
| | - Maria Kamusheva
- Department of Organization and Economics of Pharmacy, Medical University-Sofia, Sofia, Bulgaria
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Parikh KP, Motiwala M, Beer-Furlan A, Michael LM, Rangarajan SV, Choby GW, Kshettry VR, Saleh S, Mukherjee D, Kirsch C, McKean E, Sorenson JM. Skull Base Registries: A Roadmap. J Neurol Surg B Skull Base 2022; 83:561-578. [PMID: 36393883 PMCID: PMC9653294 DOI: 10.1055/a-1934-9191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 08/29/2022] [Indexed: 01/17/2023] Open
Abstract
Hospitals, payors, and patients increasingly expect us to report our outcomes in more detail and to justify our treatment decisions and costs. Although there are many stakeholders in surgical outcomes, physicians must take the lead role in defining how outcomes are assessed. Skull base lesions interact with surrounding anatomy to produce a complex spectrum of presentations and surgical challenges, requiring a wide variety of surgical approaches. Moreover, many skull base lesions are relatively rare. These factors and others often preclude the use of prospective randomized clinical trials, thus necessitating alternate methods of scientific inquiry. In this paper, we propose a roadmap for implementing a skull base registry, along with expected benefits and challenges.
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Affiliation(s)
- Kara P. Parikh
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Mustafa Motiwala
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Andre Beer-Furlan
- Department of Neurosurgery, Moffitt Cancer Center, Tampa, Florida, United States
| | - L. Madison Michael
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Sanjeet V. Rangarajan
- Department of Otolaryngology-Head and Neck Surgery, The University of Tennessee Health Science Center College of Medicine Memphis, Memphis, Tennessee, United States
| | - Garret W. Choby
- Department of Otorhinolaryngology, Mayo Clinic Rochester, Rochester, Minnesota, United States
| | - Varun R. Kshettry
- Brain Tumor and Neuro-Oncology Center Cleveland Clinic, Cleveland, Ohio, United States
| | - Sara Saleh
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States
| | - Debraj Mukherjee
- Department of Neurosurgery, Johns Hopkins Medical Institutions Campus, Baltimore, Maryland, United States
| | - Claudia Kirsch
- Yale University School of Medicine Department of Radiology and Biomedical Imaging, New Haven, Connecticut, United States
- Department of Clinical Dentistry, University of Sheffield, Sheffield, South Yorkshire, England
- Mount Sinai Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Erin McKean
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, United States
| | - Jeffrey M. Sorenson
- Department of Neurosurgery, University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States
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8
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Coopmans EC, Andela CD, Claessen KMJA, Biermasz NR. Evaluating the Impact of Acromegaly on Quality of Life. Endocrinol Metab Clin North Am 2022; 51:709-725. [PMID: 36244688 DOI: 10.1016/j.ecl.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Acromegaly has a substantial negative impact on quality of life (QoL). This review aims to discuss the impact of acromegaly on QoL from the clinical perspective as well as from the patient perspective. Furthermore, it aims to evaluate the use of patient-reported outcome measures (PROMs) in acromegaly and how PROMs aid decision-making. The recommendations presented in this review are based on recent clinical evidence on the impact of acromegaly on QoL combined with the authors' own clinical experience treating patients with acromegaly. We recommend that a patient-centered approach should be considered in treatment decisions, integrating conventional biochemical outcomes, tumor control, comorbidities, treatment complications, and PROMs, including QoL measures. This more integrated approach seems effective in treating comorbidities and improving patient-reported outcomes and is critical, as many patients do not achieve biochemical or tumor control and comorbidities, impairment in QoL may not remit even when full biochemical control is achieved.
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Affiliation(s)
- Eva C Coopmans
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, the Netherlands; Center for Endocrine Tumors Leiden (CETL), Center for Pituitary Care, Leiden University Medical Center, Albinusdreef 2, 2333 ZB Leiden, the Netherlands.
| | - Cornelie D Andela
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, the Netherlands; Center for Endocrine Tumors Leiden (CETL), Center for Pituitary Care, Leiden University Medical Center, Albinusdreef 2, 2333 ZB Leiden, the Netherlands; Basalt Rehabilitation Center, Vrederustlaan 180, 2543 SW Den Haag, the Netherlands
| | - Kim M J A Claessen
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, the Netherlands; Center for Endocrine Tumors Leiden (CETL), Center for Pituitary Care, Leiden University Medical Center, Albinusdreef 2, 2333 ZB Leiden, the Netherlands
| | - Nienke R Biermasz
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, the Netherlands; Center for Endocrine Tumors Leiden (CETL), Center for Pituitary Care, Leiden University Medical Center, Albinusdreef 2, 2333 ZB Leiden, the Netherlands.
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Camerini S, Wennberg A, Adriani M, Martin B, Vettor R, Maffei P, Dassie F. Questionnaire and tools: clinical powerful instrument in acromegaly diagnosis and management. J Endocrinol Invest 2022; 45:1823-1834. [PMID: 35322391 PMCID: PMC9463243 DOI: 10.1007/s40618-022-01782-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/07/2022] [Indexed: 12/02/2022]
Abstract
PURPOSE Acromegaly is a rare chronic disease characterized by systemic comorbidity and reduced quality of life. Although achieving biochemical control has always been the primary goal of acromegaly therapy, recent evidence has shown that the traditional assessment does not adequately capture the complexity of symptoms and patients' perception. These findings result in the need to improve a fast decision-making process of the clinician, who should not only take into account biochemical-instrumental criteria, but also patients' symptoms. With the aim of supporting the clinician in the diagnostic and therapeutic decision-making process several disease-specific tools have been developed. The aim of this review is to provide a description of the acromegaly-specific tools, presenting their main features, their application in daily practice, and their efficacy and utility. METHODS A systematic search of Medline/PubMed, ISI-Web of Knowledge, and Google Scholar databases was done. RESULTS Specific instruments and questionnaires have recently been developed to assist clinicians in the assessment of acromegaly. These are either Patient-Reported Outcome tools, such as Acromegaly Quality of Life Questionnaire (AcroQoL) and Pain Assessment Acromegaly Symptom Questionnaire (PASQ), or Clinician-Reported Outcome tools, such as ACROSCORE, SAGIT® and Acromegaly Disease Activity Tool (ACRODAT®). Such tools are extremely flexible and, therefore, have been widely adopted by endocrinologists and other professionals, so much so that they have also been included as recommendations in the 2018 international guidelines. CONCLUSION Questionnaires and tools are useful in the management of acromegaly patients. They help clinicians evaluate patients' symptoms and could assist in the evaluation of disease activity.
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Affiliation(s)
- S Camerini
- DIMED, University of Padua, Padua, Italy
| | - A Wennberg
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - M Adriani
- DIMED, University of Padua, Padua, Italy
| | - B Martin
- DIMED, University of Padua, Padua, Italy
| | - R Vettor
- DIMED, University of Padua, Padua, Italy
| | - P Maffei
- DIMED, University of Padua, Padua, Italy
| | - F Dassie
- DIMED, University of Padua, Padua, Italy.
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10
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Cangiano B, Giusti E, Premoli C, Soranna D, Vitale G, Grottoli S, Cambria V, Mantovani G, Mungari R, Maffei P, Dassie F, Giampietro A, Chiloiro S, Tanda ML, Ippolito S, Cannavò S, Ragonese M, Zambon A, Persani L, Fatti LM, Scacchi M. Psychological complications in patients with acromegaly: relationships with sex, arthropathy, and quality of life. Endocrine 2022; 77:510-518. [PMID: 35779206 PMCID: PMC9385810 DOI: 10.1007/s12020-022-03106-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/02/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Current treatment of acromegaly restores a normal life expectancy in most cases. So, the study of persistent complications affecting patients' quality of life (QoL) is of paramount importance, especially motor disability and depression. In a large cohort of acromegalic patients we aimed at establishing the prevalence of depression, to look for clinical and sociodemographic factors associated with it, and to investigate the respective roles (and interactions) of depression and arthropathy in influencing QoL. METHODS One hundred and seventy-one acromegalic patients (95 women and 76 men, aged 20-85 years) among those recruited in a cross-sectional Italian multicentric study were investigated. Each patient filled in three validated questionnaires: AcroQoL, WOMAC (measuring articular pain, stiffness and functionality), and AIMS (evaluating articular symptoms and depression). RESULTS A very high (up to 28%) depression rate was detected in acromegalic subjects. Two patients showing pathological AIMS depression scores, committed suicide during the three years observational period. In our population poor psychological status was significantly associated with female sex. Furthermore, a significant strong correlation was found between AIMS depression score and WOMAC score. Both depression and arthropathy-related motor disability turned out to independently contribute with similar strength to the impairment of QoL. CONCLUSIONS We report a high prevalence of depression in acromegaly, which is associated with female sex and arthropathy. Both depression and arthropathy strongly and independently contribute to the impaired QoL of patients. Our study shows that assessment and monitoring of psychological status is mandatory in acromegaly, also suggesting an inexpensive tool for this assessment.
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Affiliation(s)
- Biagio Cangiano
- Division of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - Emanuele Giusti
- Psychology Research Laboratory, IRCCS Istituto Auxologico Italiano, P.le Brescia 20, Milan, Italy
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Caterina Premoli
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | | | - Giovanni Vitale
- Division of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - Silvia Grottoli
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Valeria Cambria
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Giovanna Mantovani
- Endocrine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Roberta Mungari
- Endocrine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Pietro Maffei
- Department of Medicine-DIMED, University of Padua, Padua, Italy
| | | | - Antonella Giampietro
- Pituitary Unit, Section of Endocrinology, Department of Internal Medicine, Catholic University, A. Gemelli University Hospital, Rome, Italy
| | - Sabrina Chiloiro
- Pituitary Unit, Section of Endocrinology, Department of Internal Medicine, Catholic University, A. Gemelli University Hospital, Rome, Italy
| | - Maria Laura Tanda
- Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
| | - Silvia Ippolito
- Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
| | - Salvatore Cannavò
- Department of Human Pathology, University of Messina, Messina, Italy
- Endocrine Unit, University Hospital of Messina, Messina, Italy
| | - Marta Ragonese
- Department of Human Pathology, University of Messina, Messina, Italy
| | - Antonella Zambon
- Division of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Luca Persani
- Division of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - Letizia Maria Fatti
- Division of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Massimo Scacchi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
- Istituto Auxologico Italiano, IRCCS, Division of General Medicine, Ospedale S. Giuseppe, Oggebbio-Piancavallo, Verbania, Italy.
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11
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Salvatori R, Maffei P, Webb SM, Brue T, Loftus J, Valluri SR, Gomez R, Wajnrajch MP, Fleseriu M. Patient-reported outcomes in patients with acromegaly treated with pegvisomant in the ACROSTUDY extension: A real-world experience. Pituitary 2022; 25:420-432. [PMID: 35022929 DOI: 10.1007/s11102-022-01206-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/03/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To report the effects of pegvisomant (PEGV) treatment on patient-reported outcomes in acromegaly patients. METHODS We conducted an extension study of an open-label, multinational, non-interventional study (ACROSTUDY) evaluating the long-term safety and efficacy of PEGV for acromegaly in routine clinical practice. Enrolled patients were rollover patients from ACROSTUDY, or treatment naïve/semi-naïve (NSN; no PEGV within 6 months of enrollment). Exploratory efficacy endpoints were changes in symptoms with the Patient-Assessed Acromegaly Symptom Questionnaire (PASQ) and quality of life with the Acromegaly Quality of Life questionnaire (AcroQoL) analyzed by controlled or uncontrolled IGF-I levels. Results were analyzed in all patients, in NSN patient subgroup, and by diabetes status. RESULTS A total of 544 patients with acromegaly were enrolled, including 434 rollover subjects from ACROSTUDY and 110 NSN patients. Mean PEGV treatment duration was 7.8 years (range, 0-19.6 years). Overall, the majority of PASQ scores improved over time, but there was no significant difference between IGF-I controlled or uncontrolled groups. In the NSN subgroup, most PASQ and AcroQoL scores remained similar to baseline up to 1 year, regardless of IGF-I control. Patients with diabetes reported better PASQ scores over time with PEGV treatment, regardless of IGF-I control. IGF-I normalization increased from 10% of patients at baseline to more than 78% at year 10, with a mean daily PEGV dose of 18.7 mg. CONCLUSIONS Overall, patients treated with PEGV had small improvements in PASQ. While IGF-I normalization increased with PEGV treatment, IGF-I control had no effects on PASQ and AcroQoL scores.
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Affiliation(s)
- Roberto Salvatori
- Division of Endocrinology and Metabolism and Pituitary Center, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - Pietro Maffei
- Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Susan M Webb
- Department of Endocrinology/Medicine, Centro de Investigación Biomédica en Red de Enfermedades Raras, Hospital Sant Pau, Universitat Autónoma de Barcelona, Carrer de Sant Quintí 89, 08041, Barcelona, Spain
| | - Thierry Brue
- Hopital de la Conception, and Aix-Marseille Université, Marseille Medical Genetics, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | | | | | | | - Michael P Wajnrajch
- , Pfizer, New York, NY, USA
- Division of Pediatric Endocrinology, Grossman School of Medicine, New York University, New York, NY, USA
| | - Maria Fleseriu
- Pituitary Center, Departments of Medicine, Division of Endocrinology, Diabetes, & Clinical Nutrition) and Neurological Surgery, Oregon Health & Science University, Portland, OR, USA
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12
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Li Y, Zhang X, Zhang J, Zhang D, Wang Y, Zhu Y, Xu X. Stigma and unhealthy psychological characteristics in patients with acromegaly: A cross-sectional study and identification of the associated factors. Acta Neurochir (Wien) 2022; 164:2069-2081. [PMID: 35597876 DOI: 10.1007/s00701-022-05246-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 05/03/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Stigma, besides aggravating the damage caused by the disease, may also lead to unhealthy characteristics in patients and unhealthy situations in society. Individuals with acromegaly disease may suffer from stigma concerns, and the associated factors remain largely unknown. Therefore, the present cross-sectional study aimed to investigate the levels of perceived stigma in patients with acromegaly and explore the associated factors. METHODS A total of 138 patients with acromegaly were evaluated for having stigma using five previously validated scales: (i) the Stigma Scale for Chronic Illness, (ii) the Hamilton Anxiety Scale, (iii) the Rosenberg Self-Esteem Scale, (iv) the Body Image Concern scale, and (v) the Acromegaly Quality of Life scale. The potential determinants of stigma were evaluated using the univariate statistical analysis. A multivariate linear regression model was adopted to assess the predictors of stigma in patients with acromegaly. Pearson's correlation analysis was performed to analyze the relationship between stigma and the quality of life of the patients. RESULTS Among the 138 respondents, 102 provided consent for participation.The evaluated patients exhibited critically high levels of perceived stigma. The multiple regression analysis revealed high BMI, serious body image concerns, inferiority complex personality, and critical levels of anxiety as the potential predictors of stigma in patients with acromegaly. The overall stigma and internalized stigma were significantly correlated with QoL in these patients. CONCLUSION The patients with acromegaly exhibited critically high levels of perceived stigma, which led to psychological distress and disruptions in their daily lives. This finding highlights the importance of addressing the stigma concerns and the necessity for providing additional support to these patients in this regard during follow-up sessions. Further research should focus on developing intervention strategies to decrease the levels of perceived stigma in patients with acromegaly to promote their quality of life and for the psychosocial rehabilitation of these patients.
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13
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van der Meulen M, Zamanipoor Najafabadi AH, Broersen LHA, Schoones JW, Pereira AM, van Furth WR, Claessen KMJA, Biermasz NR. State of the Art of Patient-reported Outcomes in Acromegaly or GH Deficiency: A Systematic Review and Meta-analysis. J Clin Endocrinol Metab 2022; 107:1225-1238. [PMID: 34871425 PMCID: PMC9016456 DOI: 10.1210/clinem/dgab874] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Insight into the current landscape of patient-reported outcome (PRO) measures (PROM) and differences between PROs and conventional biochemical outcomes is pivotal for future implementation of PROs in research and clinical practice. Therefore, in studies among patients with acromegaly and growth hormone deficiency (GHD), we evaluated (1) used PROMs, (2) their validity, (3) quality of PRO reporting, (4) agreement between PROs and biochemical outcomes, and (5) determinants of discrepancies. EVIDENCE ACQUISITION We searched 8 electronic databases for prospective studies describing both PROs and biochemical outcomes in acromegaly and GHD patients. Quality of PRO reporting was assessed using the International Society for Quality of Life Research (ISOQOL) criteria. Logistic regression analysis was used to evaluate determinants. EVIDENCE SYNTHESIS Ninety studies were included (acromegaly: n = 53; GHD: n = 37). Besides nonvalidated symptom lists (used in 37% of studies), 36 formal PROMs were used [predominantly Acromegaly Quality of Life Questionnaire in acromegaly (43%) and Quality of Life-Assessment of Growth Hormone Deficiency in Adults in GHD (43%)]. Reporting of PROs was poor, with a median of 37% to 47% of ISOQOL items being reported per study. Eighteen (34%) acromegaly studies and 12 (32%) GHD studies reported discrepancies between PROs and biochemical outcomes, most often improvement in biochemical outcomes without change in PROs. CONCLUSIONS Prospective studies among patients with acromegaly and GHD use a multitude of PROMs, often poorly reported. Since a substantial proportion of studies report discrepancies between PROs and biochemical outcomes, PROMs are pivotal in the evaluation of disease activity. Therefore, harmonization of PROs in clinical practice and research by development of core outcome sets is an important unmet need.
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Affiliation(s)
- Merel van der Meulen
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands
- Correspondence: Merel van der Meulen, BSc, Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Amir H Zamanipoor Najafabadi
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands
- University Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Centre and Haga Teaching Hospital, Leiden and The Hague, The Netherlands
| | - Leonie H A Broersen
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan W Schoones
- Directorate of Research Policy, Leiden University Medical Center, Leiden, The Netherlands
| | - Alberto M Pereira
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands
| | - Wouter R van Furth
- University Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Centre and Haga Teaching Hospital, Leiden and The Hague, The Netherlands
| | - Kim M J A Claessen
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands
| | - Nienke R Biermasz
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands
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14
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Herman R, Goričar K, Janež A, Jensterle M. Clinical Applicability of Patient- and Clinician-Reported Outcome Tools in the Management of Patients with Acromegaly. Endocr Pract 2022; 28:678-683. [PMID: 35421593 DOI: 10.1016/j.eprac.2022.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/28/2022] [Accepted: 04/06/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We aimed to assess treatment outcomes and disease control status in patients with acromegaly by patient- and clinician-reported outcome tools and to analyse correlations among different components of both tools. METHODS Cross-sectional study included 72 patients from the national referral centre with a median follow up of 8 (5-12) years. Baseline SAGIT at the diagnosis was determined retrospectively, while the follow up SAGIT and AcroQoL results were assessed at the most recent visit and by additional telephone interviews. RESULTS All SAGIT subscores significantly lowered from baseline to follow up (global score from 14 to 4 (P<0.001)). SAGIT at baseline did not discriminate the current disease control status. However, higher baseline SAGIT score and subscore T were associated with uncontrolled disease after the first-line treatment. Diagnostic delay correlated with baseline S, A, G, and global SAGIT scores. At follow up, global SAGIT score discriminated between cured/controlled and uncontrolled groups (4 vs. 6 (P=0.007)). AcroQoL score was 69.3, with »Personal relations subscale« being the least and »Physical scale« the most affected. There was no difference in AcroQoL between patients classified as uncontrolled or cured/controlled. At baseline and follow up, there were significant negative correlations between S and A subscores and AcroQoL. Higher BMI, presence of swelling, joint symptoms, headaches, sleep apnea, and hypertension significantly impaired QoL. CONCLUSION Our results emphasised the complementary nature of patient- and clinician-reported outcome tools in acromegaly management. We identified modifiable signs, symptoms, and comorbidities as treatment targets that might help clinicians improve QoL in this population.
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Affiliation(s)
- Rok Herman
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Center Ljubljana, Ljubljana 1000, Slovenia; Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana 1000, Slovenia
| | - Katja Goričar
- Pharmacogenetics Laboratory, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Ljubljana 1000, Slovenia
| | - Andrej Janež
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Center Ljubljana, Ljubljana 1000, Slovenia; Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana 1000, Slovenia
| | - Mojca Jensterle
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Center Ljubljana, Ljubljana 1000, Slovenia; Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana 1000, Slovenia.
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15
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Danaei M, Bahadorizadeh L, Dehnad A, Mohamadzadeh S, Hashemi-Madani N, Khamseh ME. Validation of Acromegaly Quality of Life Questionnaire (AcroQoL) for the Iranian population. BMC Psychol 2022; 10:63. [PMID: 35287723 DOI: 10.1186/s40359-022-00781-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 03/11/2022] [Indexed: 11/14/2022] Open
Abstract
Background Acromegaly is a chronic disease significantly affects the physical, emotional, and health-related aspects of patients' life. This study aimed to validate the Acromegaly Quality of Life Questionnaire (AcroQoL) for the Persian-speaking population. Methods This cross-sectional study recruited 73 Iranian patients with a confirmed diagnosis of acromegaly. The content validity of the scales was evaluated by an expert panel of eight endocrinologists applying content validity index (CVI) and content validity ratio (CVR). Construct validity was assessed by using confirmatory factor analysis. Internal consistency was assessed on the basis of Cronbach’s alpha, and a goodness-of-fit (GoF) index was calculated to display whether the model fitted the data. Results CVI and CVR yielded values of 0.85 and 0.80, respectively (Acceptable CVI: > 0.78 and CVR: > 0.75). The average variances extracted (AVE) from physical and psychological dimensions were 0.520 and 0.462, respectively, exceeding the minimum criterion of 0.40. Cronbach’s alpha for physical and psychological dimensions equaled 0.868 and 0.866, respectively, indicating the adequate internal consistency of multiple items for each construct. The subscales’ R square and path coefficient were greater than the recommended threshold as 0.75 (physical dimension: 0.778, psychological dimension: 0.873), demonstrating the suitability of this criterion. Finally, the GoF value of 0.29 indicated the model's moderate fit. Conclusions The findings revealed that the Persian version of AcroQoL is of adequate validity and reliability for evaluating the quality of life of Iranian people with acromegaly. Supplementary Information The online version contains supplementary material available at 10.1186/s40359-022-00781-0.
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16
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Ting Lim DS, Fleseriu M. Personalized Medical Treatment in Patients with Acromegaly: A Review. Endocr Pract 2022; 28:321-332. [PMID: 35032649 DOI: 10.1016/j.eprac.2021.12.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 12/23/2022]
Abstract
Acromegaly is associated with significant morbidity and mortality if not appropriately treated. In addition to insulin-like growth factor 1 (IGF-1) and growth hormone (GH) normalization, and tumor shrinkage, treatment goals include symptom relief, managing complications and improving quality of life. Surgical resection is a first-line treatment in most patients, with few being pretreated pre-operatively with medications. Somatostatin receptor ligands (SRLs), injectable and more recently oral capsules, have been the cornerstone of first-line medical therapy for persistent disease. However, several factors, including sparsely granulated adenomas, absent/low somatostatin receptor (SSTR2) status, imaging T2-hyperintensity, young age and aryl hydrocarbon receptor interacting protein mutations could predict first-generation SRL resistance. Patients with these characteristics may be better candidates for the GH receptor antagonist, pegvisomant, or in cases of large tumors the second-generation SRL, pasireotide. Combination therapy should be further pursued in patients who remain biochemically uncontrolled or have high remnant tumor after monotherapy. An efficacious and cost-effective pegvisomant dose-sparing effect of SRLs when used in combination has been demonstrated. With such a wide array of medical treatment options, it is increasingly important to tailor treatment to patients' unique characteristics as well as preferences, with a goal of personalizing management to achieve high quality outcomes.
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Affiliation(s)
| | - Maria Fleseriu
- Pituitary Center, and Departments of Medicine (Endocrinology, Diabetes and Clinical Nutrition) and Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA.
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17
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Alzajaji QB, Alidrisi HA, Mansour AA. Correlation Between Clinical and Biochemical Markers in Patients With Acromegaly on Different Modalities of Treatment. Cureus 2021; 13:e19438. [PMID: 34909342 PMCID: PMC8663996 DOI: 10.7759/cureus.19438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2021] [Indexed: 12/05/2022] Open
Abstract
Background Acromegaly is a disabling disease caused by growth hormone (GH) over-secretion, associated with increased morbidity and mortality through different metabolic and somatic consequences involving soft tissue, acral overgrowth, and skin thickening, which will lead to different clinical manifestations. The study aimed to assess the correlation between biochemical markers of acromegaly with different clinical findings and biochemical control with the clinical findings. Methods A cross-sectional study was done on 56 patients with acromegaly attending a tertiary center for diabetes, endocrine, and metabolism in Southern Iraq Basrah. They were 32 (57.1%) males. Fatigue, headache, excessive sweating, joint pain, backache, soft tissue swelling, numbness, snoring, and visual problems were assessed on a four-point Likert scale. In addition, biochemical dynamic GH testing was done using a five-point random GH curve and/or standard GH suppression under the oral glucose tolerance test (OGTT). Results No significant correlation was found between symptoms severity and five-point GH parameters in respect of mean, peak, and nadir. Only backache showed a significant correlation with GH under OGTT suppression parameters in respect to mean, peak, and nadir (P-values < 0.01, < 0.01, and < 0.01), respectively. No particular biochemical control cut-off value in the 9 am random GH, mean five-point GH curve, or nadir GH under OGTT was correlated with the degree of severity for any of the clinical symptoms, as there was no difference between the biochemically controlled and uncontrolled groups in respect to any of the clinical symptom’s severity scale. Conclusion Only backache correlated with the biochemical tests of disease activity in the form of GH under OGTT. It appears in this study that the severity of the clinical symptoms does not correlate with biochemical control so that thorough evaluation and treatment of clinical complaints besides biochemical control is an essential part of the management plan in patients with acromegaly.
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Affiliation(s)
- Qusay Baqer Alzajaji
- Diabetes and Endocrinology, Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Basrah, IRQ.,Internal Medicine, University of Basrah, Basrah, IRQ
| | - Haider A Alidrisi
- Diabetes and Endocrinology, University of Basrah College of Medicine, Basrah, IRQ
| | - Abbas A Mansour
- Diabetes and Endocrinology, Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC) University of Basrah, Basrah, IRQ
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18
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Arshad MF, Ogunleye O, Ross R, Debono M. Surgically treated acromegaly patients have a similar quality of life whether controlled by surgery or requiring additional medical therapy (QuaLAT Study). Pituitary 2021; 24:768-777. [PMID: 33982222 PMCID: PMC8416856 DOI: 10.1007/s11102-021-01153-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2021] [Indexed: 11/29/2022]
Abstract
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 score (PCS) MD = - 4.9, 95% CI - 10.9 to 1.2; p = 0.12; mental component score MD = - 3.0, 95% CI - 10.5 to 4.4; p = 0.44], or FSS (MD = - 0.004, 95% CI - 1.14 to 1.33; p = 0.1). Comparison between groups 1 and 3 however showed that PCS (and 3 subdomains) was significantly better in group 3 (MD = - 8.3, 95% CI - 14.8 to -1.8; p = 0.01). All three QOL scores were lower when compared with healthy controls. CONCLUSIONS Medical treatment not only achieves a QOL comparable to surgery, it may also be associated with better QOL in physical subdomains. When compared with healthy controls, QOL remains worse in treated acromegaly patients compared to controls.
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Affiliation(s)
- Muhammad Fahad Arshad
- Department of Endocrinology and Diabetes, Sheffield Teaching Hospitals, Glossop Road, Sheffield, S10 2 JF, UK.
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.
| | - Oluwafunto Ogunleye
- Department of Endocrinology and Diabetes, Sheffield Teaching Hospitals, Glossop Road, Sheffield, S10 2 JF, UK
| | - Richard Ross
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Miguel Debono
- Department of Endocrinology and Diabetes, Sheffield Teaching Hospitals, Glossop Road, Sheffield, S10 2 JF, UK
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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19
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de Alegria SG, Kasuki L, Gadelha M, Lopes AJ. The Glittre Activities of Daily Living Test in patients with acromegaly: Associations with hand function and health-related quality of life. J Back Musculoskelet Rehabil 2021; 34:441-451. [PMID: 33492273 DOI: 10.3233/bmr-200089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
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.
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Affiliation(s)
| | - Leandro Kasuki
- Neuroendocrinology Research Centre/Endocrinology Section, Medical School and Clementino Fraga Filho University Hospital, Federal University of the Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.,Neuroendocrine Unit, Paulo Niemeyer State Brain Institute, Secretary of State for Health of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Monica Gadelha
- Neuroendocrinology Research Centre/Endocrinology Section, Medical School and Clementino Fraga Filho University Hospital, Federal University of the Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.,Neuroendocrine Unit, Paulo Niemeyer State Brain Institute, Secretary of State for Health of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Agnaldo José Lopes
- Rehabilitation Sciences, Augusto Motta University Center (UNISUAM), Rio de Janeiro, Brazil.,School of Medical Sciences, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
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20
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Sarris CE, Little AS, Kshettry VR, Rosen MR, Rehl RM, Haegen TW, Rabinowitz MR, Nyquist GG, Recinos PF, Sindwani R, Woodard TD, Farrell CJ, Santarelli GD, Milligan J, Evans JJ. Assessment of the Validity of the Sinonasal Outcomes Test-22 in Pituitary Surgery: A Multicenter Prospective Trial. Laryngoscope 2021; 131:E2757-E2763. [PMID: 34196397 DOI: 10.1002/lary.29711] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/24/2021] [Accepted: 06/15/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVES/HYPOTHESIS Sinonasal Outcomes Test-22 (SNOT-22) is used widely as a patient-reported sinonasal quality-of-life (QOL) instrument for endoscopic endonasal pituitary surgery. However, it has never been validated in this population. This study explores the psychometric validity of SNOT-22 to determine if it is a valid scale in patients undergoing endoscopic pituitary surgery. STUDY DESIGN Multicenter prospective trial. METHODS Adult patients (n = 113) with pituitary tumors undergoing endoscopic surgery were enrolled in a multicenter study. Patient-reported QOL was assessed using SNOT-22 and the Anterior Skull Base Nasal Inventory-12. Face validity, internal consistency, responsiveness to clinical change, test-retest reliability, and concurrent validity were determined using standard statistical methods. RESULTS Internal consistency using Cronbach's alpha at baseline and 2 weeks postoperatively were 0.911 and 0.922, indicating SNOT-22 performed well as a single construct. Mean QOL scores were significantly worse at 2 weeks than baseline (16.4 ± 15.1 vs. 23.1 ± 16.4, P < .001), indicating the scale is responsive to clinical change. However, only 11/22 items demonstrated significant changes in mean scores at 2 weeks. Correlation between scores at 2 and 3 weeks was high, suggesting good test-retest reliability, r(107) = 0.75, P < .001. Factor analysis suggests the five-factor solution proposed for the SNOT-22 in rhinosinusitis patients is not valid in pituitary surgery patients. CONCLUSIONS The SNOT-22 is a valid QOL instrument in patients undergoing endoscopic pituitary surgery. However, because it includes 22 items, can be applied only as a single construct, 50% of the items do not demonstrate changes after surgery, and is not as sensitive to change as other scales, shorter instruments developed specifically for this patient population may be preferable. LEVEL OF EVIDENCE II Laryngoscope, 2021.
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Affiliation(s)
- Christina E Sarris
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, U.S.A
| | - Andrew S Little
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, U.S.A
| | - Varun R Kshettry
- Department of Neurosurgery and Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
| | - Marc R Rosen
- Department of Otolaryngology-Head & Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Ryan M Rehl
- Arizona Sinus Center, Valley ENT, Phoenix, Arizona, U.S.A
| | | | - Mindy R Rabinowitz
- Department of Otolaryngology-Head & Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Gurston G Nyquist
- Department of Otolaryngology-Head & Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Pablo F Recinos
- Department of Neurosurgery and Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A.,Department of Otolaryngology, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
| | - Raj Sindwani
- Department of Neurosurgery and Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A.,Department of Otolaryngology, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
| | - Troy D Woodard
- Department of Neurosurgery and Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A.,Department of Otolaryngology, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
| | - Christopher J Farrell
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | | | - John Milligan
- Arizona Otolaryngology Consultants, Phoenix, Arizona, U.S.A
| | - James J Evans
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
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21
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Ballesteros-Herrera D, Briseño-Hernández P, Pérez-Esparza R, Portocarrero-Ortiz LA. Differences in quality of life between genders in acromegaly. Endocrinol Diabetes Metab 2021; 4:e00229. [PMID: 33855226 PMCID: PMC8029512 DOI: 10.1002/edm2.229] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 12/31/2020] [Accepted: 01/09/2021] [Indexed: 11/09/2022]
Abstract
Objective To study the impact of secondary mental disorders in patients affected with acromegaly and correlate them with quality of life (QoL) and disease status. Design An observational transversal descriptive and comparative study that evaluates QoL's impact due to secondary mental disorders in affected Mexicans with acromegaly using AcroQoL and SF‐36 instruments. Correlation of the results with the disease's biochemical status was performed. According to Beck's scales, anxiety and depression analyses evaluate QoL's impact, and its gender variability is described. Results Eighty‐five patients with diagnoses of acromegaly were included. The mean age was 43.18 years, 47 being women (55.29%). The mean age at diagnosis was 37.95 years, with no difference between men and women. AcroQoL and SF‐36 global and sub‐domain scores differed significantly between men and women, the latter having lower global and individual sub‐domain scores. The mean score of QoL, according to AcroQoL, is 59.40. In women, the mean values are less (55.13) than men (64.68), p = 0.021. The sub‐domain analyses’ scores in physical, appearance and social relationships were less in women (53.21; 47.34; 62.32) than men (62.68; 56.76; 73.87) p = 0.044, 0.069 and 0.013, respectively. Higher Beck's Depression Inventory (BDI) and Beck's Anxiety Inventory (BAI) scores correlated with lower QoL as assessed by global and individual sub‐domain scores. Women presented significantly higher BDI and BAI mean scores when compared to men regardless of their biochemical status. Anxiety (p = 0.027) and depression (p < 0.001) severity were higher in women compared to men. Conclusion Correlations between female gender, depression/anxiety scores and QoL require further validation. There is much to be routinely done to improve secondary psychopathology in patients affected by this disease. The need for mental status screening at diagnosis should be emphasized to identify secondary mental illnesses to improve QoL with its treatment.
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Affiliation(s)
| | | | | | - Lesly A Portocarrero-Ortiz
- Universidad Nacional Autónoma de México Mexico City Mexico.,Department of Neuroendocrinology INNN Mexico City Mexico
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22
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Broersen LHA, Zamanipoor Najafabadi AH, Pereira AM, Dekkers OM, van Furth WR, Biermasz NR. Improvement in Symptoms and Health-Related Quality of Life in Acromegaly Patients: A Systematic Review and Meta-Analysis. J Clin Endocrinol Metab 2021; 106:577-587. [PMID: 33245343 PMCID: PMC7823264 DOI: 10.1210/clinem/dgaa868] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Whereas biochemical response is often used as a primary study outcome, improvement in symptoms and health-related quality of life (HRQoL) is the relevant goal for patients to consider treatment successful. We performed a systematic review and meta-analysis to assess the effect of treatment on symptoms and HRQoL in acromegaly. METHODS Seven electronic databases were searched for longitudinal studies assessing patient-reported symptoms or HRQoL in acromegaly. Meta-analyses were performed to assess differences during treatment for the Acromegaly Quality of Life Questionnaire (AcroQoL) and Patient-Assessed Acromegaly Symptom Questionnaire (PASQ), and standardized mean difference (SMD) for individual symptoms (interpretation: 0.2 small, 0.5 moderate, and 0.8 large effect). Treatment-naive and previously treated patients were assessed separately. RESULTS Forty-six studies with 3301 patients were included; 24 contributed to quantitative analyses. Thirty-six studies used medication as main treatment, 1 transsphenoidal adenomectomy, and 9 various treatments. Symptoms and HRQoL both improved: AcroQoL increased 2.9 points (95% CI, 0.5 to 5.3 points), PASQ decreased -2.3 points (95% CI, -1.3 to -3.3 points), and individual symptom scores decreased for paresthesia -0.9 (95% CI, -0.6 to -1.2), hyperhidrosis -0.4 (95% CI, -0.1 to -0.6), fatigue -0.3 (95% CI, -0.1 to -0.6), arthralgia -0.3 (95% CI, -0.1 to -0.5), headache -0.3 (95% CI, 0.0 to -0.6), and soft-tissue swelling -0.2 (95% CI, 0.0 to -0.4). CONCLUSION Symptoms and HRQoL improved during acromegaly treatment. Consensus is needed on which symptoms should be included in a potential core outcome set, taking into account symptom frequency, severity, and sensitivity to change, which can be used in clinical practice and as outcome in trials.
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Affiliation(s)
- Leonie H A Broersen
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, ZA Leiden, the Netherlands
| | - Amir H Zamanipoor Najafabadi
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, ZA Leiden, the Netherlands
- Center for Innovative Pituitary Care and Cranial Base Surgery, Leiden University Medical Center, ZA Leiden, the Netherlands
- University Neurosurgical Centre Holland, Leiden University Medical Centre, Haaglanden Medical Centre and Haga Teaching Hospital, ZA Leiden and The Hague, the Netherlands
| | - Alberto M Pereira
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, ZA Leiden, the Netherlands
- Center for Innovative Pituitary Care and Cranial Base Surgery, Leiden University Medical Center, ZA Leiden, the Netherlands
| | - Olaf M Dekkers
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, ZA Leiden, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, ZA Leiden, the Netherlands
| | - Wouter R van Furth
- Center for Innovative Pituitary Care and Cranial Base Surgery, Leiden University Medical Center, ZA Leiden, the Netherlands
- University Neurosurgical Centre Holland, Leiden University Medical Centre, Haaglanden Medical Centre and Haga Teaching Hospital, ZA Leiden and The Hague, the Netherlands
| | - Nienke R Biermasz
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, ZA Leiden, the Netherlands
- Center for Innovative Pituitary Care and Cranial Base Surgery, Leiden University Medical Center, ZA Leiden, the Netherlands
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23
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Störmann S, Schopohl J, Bullmann C, Terkamp C, Christ-Crain M, Finke R, Flitsch J, Kreitschmann-Andermahr I, Luger A, Stalla G, Houchard A, Helbig D, Petersenn S. Multicenter, Observational Study of Lanreotide Autogel for the Treatment of Patients with Acromegaly in Routine Clinical Practice in Germany, Austria and Switzerland. Exp Clin Endocrinol Diabetes 2020; 129:224-233. [PMID: 33285601 DOI: 10.1055/a-1247-4713] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Evidence from controlled trials has shown that lanreotide autogel is effective in achieving biochemical and symptom control in patients with acromegaly. However, it is important to better understand the real-world patient population receiving lanreotide autogel treatment. METHODS In this non-interventional study the long-term treatment response to lanreotide autogel in adult patients with acromegaly from office-based centers or clinics in Germany, Austria and Switzerland was studied. Assessments included growth hormone and insulin-like growth factor-I levels, symptoms, quality of life, lanreotide plasma levels and tumor somatostatin receptor subtype expression. The primary endpoint was achievement of full biochemical control, defined as growth hormone ≤2.5 µg/L and insulin-like growth factor I normalization at month 12. RESULTS 76 patients were enrolled from 21 sites. 7/51 (13.7%) patients of the efficacy population had full biochemical control at baseline, 15/33 (45.5%) at month 12 and 10/26 (38.5%) at month 24 of treatment. At 12 months of treatment higher rates of biochemical control were observed in the following subgroups: older patients (>53 years [median]), females, treatment-naïve patients, and patients with a time since diagnosis of longer than 1.4 years (median). No clinically relevant differences in acromegaly symptoms or quality of life scores were observed. Median fasting blood glucose and glycated hemoglobin levels remained unchanged throughout the study. No new safety signals were observed. Overall tolerability of treatment with lanreotide autogel was judged by 80.8% of the enrolled patients at month 12 as 'very good' or 'good'. CONCLUSION Treatment with lanreotide autogel in a real-world setting showed long-term effectiveness and good tolerability in patients with acromegaly.
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Affiliation(s)
- Sylvère Störmann
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, München, Germany
| | - Jochen Schopohl
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, München, Germany
| | | | - Christoph Terkamp
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover
| | - Mirjam Christ-Crain
- Clinic of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel
| | | | - Jörg Flitsch
- Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg
| | - Ilonka Kreitschmann-Andermahr
- Department of Neurosurgery and Spine Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - Anton Luger
- Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna
| | - Günter Stalla
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, München, Germany.,MEDICOVER Neuroendocrinology MVZ, Munich
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24
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Bernabéu I, Fajardo C, Marazuela M, Cordido F, Venegas EM, de Pablos-Velasco P, Maroto GP, Olvera MP, de Paz IP, Carvalho D, Romero C, De la Cruz G, Escolá CÁ. Effectiveness of lanreotide autogel 120 mg at extended dosing intervals for acromegaly. Endocrine 2020; 70:575-583. [PMID: 32725444 PMCID: PMC7674328 DOI: 10.1007/s12020-020-02424-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/13/2020] [Indexed: 12/03/2022]
Abstract
PURPOSE Recent data indicate that extended dosing intervals (EDIs) with lanreotide autogel 120 mg are effective and well-received among patients with acromegaly who have achieved biochemical control with monthly injections of long-acting somatostatin analogues (SSAs). We further evaluated the effectiveness of lanreotide autogel 120 mg delivered at EDIs (>4 weeks) in routine clinical practice. METHODS Cross-sectional, multicentre, observational study conducted to determine the effectiveness-measured by control of serum insulin-like growth factor 1 (IGF-1)-of lanreotide autogel 120 mg at dosing intervals >4 weeks for ≥6 months in selected patients with acromegaly treated in routine clinical practice (NCT02807233). Secondary assessments included control of growth hormone (GH) levels, treatment adherence, patient satisfaction, and quality of life (QoL) using validated questionnaires (EQ-5D, AcroQoL, and TSQM-9). Patients who received radiotherapy within the last 6 months were excluded. RESULTS Among 109 patients evaluated, mean (SD) age was 59.1 (13.2) years. IGF-1 values were normal (mean [SD]: 175.0 [74.5], 95% CI: 160.8 -189.1) in 91.7% of cases and normal in 91.4% of patients without previous radiotherapy treatment (n = 81). GH levels were ≤2.5 and ≤1 ng/mL, respectively, in 80.6% and 58.3%. Most patients were treated either every 5-6 (57.8%) or 7-8 weeks (38.5%), with 2.8% treated greater than every 8 weeks. The mean AcroQoL score was 63.0 (20.1). The mean global treatment satisfaction score (TSQM-9) was 75.1 (16.6). Treatment adherence (defined as no missed injections) was 94.5%. CONCLUSION Lanreotide autogel 120 mg at intervals of >4 weeks provided IGF-1 control in more than 90% of patients with acromegaly. Treatment satisfaction and adherence were good. These findings support use of extended dosing intervals in patients who have achieved good biochemical control with long-acting SSAs.
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Affiliation(s)
- Ignacio Bernabéu
- Endocrinology and Nutrition Department, Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela, Spain.
| | - Carmen Fajardo
- Endocrinology and Nutrition Department, Hospital Universitario de La Ribera, Alzira (Valencia), Spain
| | - Mónica Marazuela
- Endocrinology and Nutrition Department, Hospital Universitario La Princesa, Universidad Autónoma Madrid, Instituto Princesa, Madrid, Spain
| | - Fernando Cordido
- Faculty of Health Sciences and INIBIC, University of A Coruña, and Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Eva María Venegas
- Endocrinology and Nutrition Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Pedro de Pablos-Velasco
- Endocrinology and Nutrition Department, University of Las Palmas de Gran Canaria. Spain, Las Palmas, Spain
| | - Gonzalo Piedrola Maroto
- Endocrinology and Nutrition Departament Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - María Pilar Olvera
- Endocrinology and Nutrition Departament, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Isabel Pavón de Paz
- Endocrinology and Nutrition Departament, Hospital Universitario de Getafe, Madrid, Spain
| | - Davide Carvalho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário São João, Faculty of Medicine, i3S, Universidade do Porto, Porto, Portugal
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25
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Ozturk Gokce B, Gogus F, Bolayir B, Tecer D, Gokce O, Eroglu Altinova A, Balos Toruner F, Akturk M. The evaluation of the tendon and muscle changes of lower extremity in patients with acromegaly. Pituitary 2020; 23:338-346. [PMID: 32200458 DOI: 10.1007/s11102-020-01037-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
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.
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Affiliation(s)
- Birsen Ozturk Gokce
- Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Feride Gogus
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Basak Bolayir
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, 06560, Turkey.
| | - Duygu Tecer
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Onur Gokce
- Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Alev Eroglu Altinova
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, 06560, Turkey
| | - Fusun Balos Toruner
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, 06560, Turkey
| | - Mujde Akturk
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, 06560, Turkey
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26
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Fleseriu M, Fogelfeld L, Gordon MB, Sisco J, Crosby RD, Ludlam WH, Haviv A, Mathias SD. An evaluation of the Acromegaly Treatment Satisfaction Questionnaire (Acro-TSQ) in adult patients with acromegaly, including correlations with other patient-reported outcome measures: data from two large multicenter international studies. Pituitary 2020; 23:347-358. [PMID: 32221764 PMCID: PMC7316852 DOI: 10.1007/s11102-020-01038-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE The Acromegaly Treatment Satisfaction Questionnaire (Acro-TSQ) is a new patient-reported outcome (PRO) measure for patients with acromegaly receiving injectable somatostatin analogs (SSAs) to assess clinical symptoms and adverse drug reaction interference, treatment satisfaction, and convenience. We evaluated its scale structure, reliability, validity, responsiveness, and what constitutes clinically meaningful change. METHODS Data from two longitudinal studies (N = 79 and 82) of patients receiving a stable injectable SSA dose for ≥ 6 months who completed the Acro-TSQ and other collateral measures (e.g., AcroQoL, AIS, WPAI:SHP, EQ-5D-5L) were analyzed. RESULTS The first study demonstrated internal consistency of the Acro-TSQ. However, several items had high ceiling effects, responsiveness could not be established, and the minimally important difference (MID) was not estimable. In the second study, factor analysis revealed six scales: Symptom Interference, Treatment Convenience, Injection Site Interference, GI Interference, Treatment Satisfaction, and Emotional Reaction. Internal consistency and test-retest reliability were confirmed; most scales demonstrated significant differences in mean scores by disease severity. Correlations between Acro-TSQ scales and other collateral measures exceeded 0.30 in absolute value, confirming convergent validity. Responsiveness in Acro-TSQ scale scores reflected improved disease control. The MID was estimated for Symptom Interference (10-12 points), Treatment Convenience (9-11) and GI Interference (8-10). CONCLUSIONS The Acro-TSQ is a brief, yet comprehensive tool to monitor important outcomes associated with injectable acromegaly SSA treatments. Its content reflects both disease and treatment burden as well as patient satisfaction, and its relevant for use in clinical studies.
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Affiliation(s)
- Maria Fleseriu
- Departments of Medicine and Neurological Surgery and Northwest Pituitary Center, Oregon Health and Science University, 3303 SW Bond Ave, CH8N, Portland, OR, 97239, USA.
| | - Leon Fogelfeld
- John H. Stroger Jr. Hospital of Cook County, Rush University Medical Center, Chicago, IL, USA
| | - Murray B Gordon
- Allegheny Neuroendocrinology Center, Allegheny General Hospital, Pittsburgh, PA, USA
| | | | - Ross D Crosby
- Health Outcomes Solutions, Winter Park, FL, USA
- Neuropsychiatric Research Institute, Fargo, ND, USA
- University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
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27
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Coopmans EC, El-Sayed N, Frystyk J, Magnusson NE, Jørgensen JOL, van der Lely AJ, Janssen JAMJL, Muhammad A, Neggers SJCMM. Soluble Klotho: a possible predictor of quality of life in acromegaly patients. Endocrine 2020; 69:165-174. [PMID: 32333268 PMCID: PMC7343750 DOI: 10.1007/s12020-020-02306-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 04/04/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Although quality of life (QoL) is improved in patients with acromegaly after disease control, QoL correlates only weakly with traditional biomarkers. Our objective is to investigate a potential relation between the new serum biomarker soluble Klotho (sKlotho), GH and insulin-like growth factor 1 (IGF-1) levels, and QoL. METHODS In this prospective cohort study, we investigated 54 acromegaly patients biochemically well-controlled on combination treatment with first-generation somatostatin receptor ligands (SRLs) and pegvisomant (PEGV) at baseline and 9 months after switching to pasireotide LAR (PAS-LAR; either as monotherapy, n = 28; or in combination with PEGV, n = 26). QoL was measured by the Patient-Assessed Acromegaly Symptom Questionnaire (PASQ) and Acromegaly Quality of Life (AcroQoL) questionnaire. RESULTS Switching to PAS-LAR treatment significantly improved QoL without altering IGF-1 levels. QoL did not correlate with GH or IGF-1 levels, but sKlotho correlated with the observed improvements in QoL by the AcroQoL global (r = -0.35, p = 0.012) and physical subdimension (r = -0.34, p = 0.017), and with PASQ headache (r = 0.28, p = 0.048), osteoarthralgia (r = 0.46, p = 0.00080) and soft tissue swelling score (r = 0.29, p = 0.041). Parallel changes in serum sKlotho and IGF-1 (r = 0.31, p = 0.023) suggest sKlotho and IGF-1 to be similarly dependent on GH. Comparing the PAS-LAR combination therapy and the monotherapy group we did not observe a significant difference in improvement of QoL. CONCLUSIONS Patients experienced improved QoL during PAS-LAR, either as monotherapy or in combination with PEGV. Soluble Klotho concentrations appear to be a useful marker of QoL in acromegaly patients but the underlying mechanisms remain to be investigated.
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Affiliation(s)
- Eva C Coopmans
- Department of Medicine, Section Endocrinology, Pituitary Center Rotterdam, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Nour El-Sayed
- Department of Medicine, Section Endocrinology, Pituitary Center Rotterdam, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jan Frystyk
- Medical Research Laboratory, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Nils E Magnusson
- Medical Research Laboratory, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jens O L Jørgensen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Aart-Jan van der Lely
- Department of Medicine, Section Endocrinology, Pituitary Center Rotterdam, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joop A M J L Janssen
- Department of Medicine, Section Endocrinology, Pituitary Center Rotterdam, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ammar Muhammad
- Department of Medicine, Section Endocrinology, Pituitary Center Rotterdam, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Sebastian J C M M Neggers
- Department of Medicine, Section Endocrinology, Pituitary Center Rotterdam, Erasmus University Medical Center, Rotterdam, The Netherlands
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28
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Gu J, Xiang S, He M, Wang M, Gu Y, Li L, Yin Z. Quality of Life in Patients with Acromegaly before and after Transsphenoidal Surgical Resection. Int J Endocrinol 2020; 2020:5363849. [PMID: 32831834 PMCID: PMC7424368 DOI: 10.1155/2020/5363849] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/08/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We aimed to determine the perioperative changes in the quality of life (QoL) in patients with acromegaly and to reveal the relationship between biochemical indicators and quality of life change after tumor resection. METHODS Patients with acromegaly were enrolled from a tertiary pituitary center. SF-36 scale and AcroQoL scale were used to determine the QoL before and after surgery. We analyzed changes in QoL using a generalized linear model for repeated measurements. We compared the changes in QoL among three groups (remission, active, and discordant group) based on postoperative growth hormone (GH) and insulin-like growth factor-1. RESULTS 151 patients (75 males and 76 females) diagnosed with acromegaly were included. The average age was 43.9 ± 12.3 years. The median total SF-36 scale was 65.3% (IQR: 63.2%-69.2%). Overall AcroQoL score at baseline was 59.1% (IQR: 51.8%-71.8%). Nadir GH levels (coefficient -0.08, p=0.047), T3 levels (coefficient 2.8, p=0.001), and testosterone levels (coefficient -0.20, p=0.033) in males were independent predictive factors of the total SF-36 score. During the follow-up, the median overall SF-36 score increased to 66.1% at 3 months and 75.3% at 6 months (p < 0.001) after surgery. The median overall AcroQoL score increased to 74.5% at 3 months and 77.3% at 6 months (p < 0.001) after surgery. At 6-month follow-up, median scores were still less than 70% in appearance, vitality, and mental health dimensions. The QoL after surgery were similar among the three groups, although higher GH and more preoperative somatostatin analogs usage were observed in the active group. CONCLUSION In conclusion, acromegalic patients were associated with low QoL, which could be reversed partially by surgery. The improvement was independent of the endocrine remission. Appearance, vitality, and mental health were three major aspects that warrant further attention from physicians and caregivers after surgery.
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Affiliation(s)
- Jing Gu
- Department of Nursery, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Shiyuan Xiang
- Department of Nursery, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Min He
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Meng Wang
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Yanfang Gu
- Department of Nursery, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Lingjuan Li
- Department of Nursery, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Zhiwen Yin
- Department of Nursery, Huashan Hospital, Fudan University, Shanghai 200040, China
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Cozzi R, Ambrosio MR, Attanasio R, Bozzao A, De Marinis L, De Menis E, Guastamacchia E, Lania A, Lasio G, Logoluso F, Maffei P, Poggi M, Toscano V, Zini M, Chanson P, Katznelson L. Italian Association of Clinical Endocrinologists (AME) and Italian AACE Chapter Position Statement for Clinical Practice: Acromegaly - Part 2: Therapeutic Issues. Endocr Metab Immune Disord Drug Targets 2020; 20:1144-1155. [PMID: 31995025 PMCID: PMC7579256 DOI: 10.2174/1871530320666200129113328] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/02/2019] [Accepted: 12/02/2019] [Indexed: 12/03/2022]
Abstract
Any newly diagnosed patient should be referred to a multidisciplinary team experienced in the treatment of pituitary adenomas. The therapeutic management of acromegaly always requires a personalized strategy. Normal age-matched IGF-I values are the treatment goal. Transsphenoidal surgery by an expert neurosurgeon is the primary treatment modality for most patients, especially if there are neurological complications. In patients with poor clinical conditions or who refuse surgery, primary medical treatment should be offered, firstly with somatostatin analogs (SSAs). In patients who do not reach hormonal targets with first-generation depot SSAs, a second pharmacological option with pasireotide LAR or pegvisomant (alone or combined with SSA) should be offered. Irradiation could be proposed to patients with surgical remnants who would like to be free from long-term medical therapies or those with persistent disease activity or tumor growth despite surgery or medical therapy. Since the therapeutic tools available enable therapeutic targets to be achieved in most cases, the challenge is to focus more on the quality of life.
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Affiliation(s)
- Renato Cozzi
- Address correspondence to this author at the Endocrinologia, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milano, Italy; Tel: +39.347.5225490; E-mail:
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Abstract
PURPOSE Somatostatin analogs (SSAs) represent a mainstay of medical treatment for acromegaly, currently available as either intramuscular or deep subcutaneous injections. Patient-reported outcomes (PROs) are increasingly common as relevant outcomes in studies of acromegaly and its treatment, but there are no validated PRO measures available that focus on the disease burden and the impact of treatment, specifically designed for use in patients with acromegaly. We sought to develop a new and unique PRO measure, the Acromegaly Treatment Satisfaction Questionnaire (Acro-TSQ). METHODS Concept elicitation (CE) interviews were conducted with acromegaly patients in the United States receiving SSA injections at a stable dose for ≥ 6 months. A questionnaire was drafted based on these interviews; combined CE and cognitive debriefing (CE/CD) interviews were then conducted to confirm the content, clarity, and relevance of the questionnaire. RESULTS Nineteen subjects completed interviews [n = 9 CE, n = 10 CE/CD; n = 15 Lanreotide Depot/Autogel (Somatuline), n = 4 Octreotide LAR (Sandostatin LAR)]. Most subjects responded positively when asked about the effectiveness of their current treatment; however, breakthrough symptoms, injection site reactions, and side effects were commonly reported and had negative impacts on social and emotional well-being and daily activities. All 10 subjects involved in debriefing interviews found the questionnaire to be relevant, easy to complete, and found the response options to be clear. The resulting 26-item Acro-TSQ covers symptoms and symptom control, gastrointestinal side effects and their impact on daily activities, the emotional impact of treatment, convenience and ease of use, and overall satisfaction. CONCLUSIONS The Acro-TSQ is a novel PRO, focused on both disease burden and impact of treatment; it was found to be comprehensive, clear, and relevant for patients with acromegaly receiving injectable SSA treatment.
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Affiliation(s)
- Maria Fleseriu
- Departments of Neurosurgery and Medicine, Northwest Pituitary Center, Oregon Health and Science University, 3303 SW Bond Ave, CH8N, Portland, OR, 97239, USA.
| | - Leon Fogelfeld
- John H. Stroger Jr. Hospital of Cook County, Rush University Medical Center, Chicago, IL, USA
| | - Murray B Gordon
- Allegheny Neuroendocrinology Center, Allegheny General Hospital, Pittsburgh, PA, USA
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Pertichetti M, Serioli S, Belotti F, Mattavelli D, Schreiber A, Cappelli C, Padovani A, Gasparotti R, Nicolai P, Fontanella MM, Doglietto F. Pituitary adenomas and neuropsychological status: a systematic literature review. Neurosurg Rev 2019; 43:1065-1078. [DOI: 10.1007/s10143-019-01134-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/16/2019] [Accepted: 06/10/2019] [Indexed: 12/16/2022]
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Abstract
Pituitary diseases are rare conditions with severe chronic multiorgan and multisystemic morbidity requiring complex multidisciplinary treatment and usually life-long drug treatment. Most cases are caused by functioning or non-functioning pituitary adenoma. From the patient's perspective, the burden of disease is caused by the tumour itself and associated compression symptoms, interventions, hormone excess and deficiencies, systemic manifestations of these endocrine abnormalities and general psychosocial issues that can manifest in patients with a chronic condition. In this review, patient burden is classified according to classic endocrine syndromes, with burden at diagnosis and after long-term remission, and also within the framework of value-based health care and the conceptual model of wellbeing. The recently developed patient-reported outcome measurement tool that helps to evaluate burden of patients is also discussed.
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Affiliation(s)
- Nienke R Biermasz
- Leiden University Medical Center, Department of Medicine, Division of Endocrinology, Center of Endocrine Tumors Leiden, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands.
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Lima TRL, Kasuki L, Gadelha MR, Lopes AJ. The effectiveness of a therapist-oriented home rehabilitation program for a patient with acromegaly: A case study. J Bodyw Mov Ther 2019; 23:634-42. [PMID: 31563382 DOI: 10.1016/j.jbmt.2019.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 01/24/2019] [Indexed: 12/26/2022]
Abstract
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.
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Ishikawa T, Takeuchi K, Nagatani T, Aimi Y, Tanemura E, Tambara M, Nagata Y, Choo J, Wakabayashi T. Quality of Life Changes Before and After Transsphenoidal Surgery for Sellar and Parasellar Lesions. World Neurosurg 2018; 122:e1202-e1210. [PMID: 30447458 DOI: 10.1016/j.wneu.2018.11.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 11/01/2018] [Accepted: 11/03/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Although reports regarding the relationship between surgical complications and quality of life (QOL) exist, a general consensus regarding this issue is lacking. The aim of this study was to evaluate QOL after endoscopic transsphenoidal approach. METHODS We assessed patients with sellar or parasellar lesions that were removed with endoscopic transsphenoidal approach or extended endoscopic transsphenoidal approach between January 2010 and December 2016. 36-Item Short Form Health Survey and 30-Item General Health Questionnaire QOL scores were obtained preoperatively and 1 month and 6 months postoperatively. RESULTS We analyzed 89 patients with nonfunctioning pituitary adenoma (NFPA) and 39 patients with acromegaly. Physical QOL decreased 1 month after surgery but recovered after 6 months in both groups. Mental QOL improved postoperatively compared with preoperatively. Patients with acromegaly had a worse Physical Component Summary (PCS) on 36-Item Short Form Health Survey (48.7, 28.9, and 41.0) at 6 months than patients with NFPA. The low preoperative PCS group did not improve until 6 months postoperatively. Multiple regression analysis revealed the following factors were key to postoperative QOL: age (NFPA PCS 6 months postoperatively; correlation coefficient = -0.489), preoperative Mental Component Summary (MCS) (NFPA MCS 6 months postoperatively, correlation coefficient = 0.573), body mass index (acromegaly PCS 6 months postoperatively; correlation coefficient = -0.376), preoperative PCS (acromegaly PCS 6 months postoperatively; correlation coefficient = 0.905), and preoperative MCS (acromegaly MCS 6 months postoperatively; correlation coefficient = 0.726). CONCLUSIONS Endoscopic transsphenoidal approach can improve QOL in patients by 6 months postoperatively. In patients with acromegaly with significant QOL impairments preoperatively, surgery sometimes may be unable to normalize QOL.
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Affiliation(s)
- Takayuki Ishikawa
- Department of Neurosurgery, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan; Department of Neurosurgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi, Japan.
| | - Kazuhito Takeuchi
- Department of Neurosurgery, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan
| | - Tetsuya Nagatani
- Department of Neurosurgery, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan; Department of Neurosurgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Yuri Aimi
- Department of Neurosurgery, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan; Department of Neurosurgery, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
| | - Eriko Tanemura
- Department of Neurosurgery, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan; Department of Neurosurgery, Chuno Kosei Hospital, Seki, Gifu, Japan
| | - Masao Tambara
- Department of Neurosurgery, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan; Department of Neurosurgery, Okazaki City Hospital, Okazaki, Aichi, Japan
| | - Yuichi Nagata
- Department of Neurosurgery, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan
| | - Jungsu Choo
- Department of Neurosurgery, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan; Department of Neurosurgery, Chukyo Hospital, Nagoya, Aichi, Japan
| | - Toshihiko Wakabayashi
- Department of Neurosurgery, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan
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Trainer PJ, Newell-Price JDC, Ayuk J, Aylwin SJB, Rees A, Drake W, Chanson P, Brue T, Webb SM, Fajardo C, Aller J, McCormack AI, Torpy DJ, Tachas G, Atley L, Ryder D, Bidlingmaier M. A randomised, open-label, parallel group phase 2 study of antisense oligonucleotide therapy in acromegaly. Eur J Endocrinol 2018; 179:97-108. [PMID: 29789410 PMCID: PMC6063983 DOI: 10.1530/eje-18-0138] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 05/22/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE ATL1103 is a second-generation antisense oligomer targeting the human growth hormone (GH) receptor. This phase 2 randomised, open-label, parallel-group study assessed the potential of ATL1103 as a treatment for acromegaly. DESIGN Twenty-six patients with active acromegaly (IGF-I >130% upper limit of normal) were randomised to subcutaneous ATL1103 200 mg either once or twice weekly for 13 weeks and monitored for a further 8-week washout period. METHODS The primary efficacy measures were change in IGF-I at week 14, compared to baseline and between cohorts. For secondary endpoints (IGFBP3, acid labile subunit (ALS), GH, growth hormone-binding protein (GHBP)), comparison was between baseline and week 14. Safety was assessed by reported adverse events. RESULTS AND CONCLUSIONS Baseline median IGF-I was 447 and 649 ng/mL in the once- and twice-weekly groups respectively. Compared to baseline, at week 14, twice-weekly ATL1103 resulted in a median fall in IGF-I of 27.8% (P = 0.0002). Between cohort comparison at week 14 demonstrated the median fall in IGF-I to be 25.8% (P = 0.0012) greater with twice-weekly dosing. In the twice-weekly cohort, IGF-I was still declining at week 14, and remained lower at week 21 than at baseline by a median of 18.7% (P = 0.0005). Compared to baseline, by week 14, IGFBP3 and ALS had declined by a median of 8.9% (P = 0.027) and 16.7% (P = 0.017) with twice-weekly ATL1103; GH had increased by a median of 46% at week 14 (P = 0.001). IGFBP3, ALS and GH did not change with weekly ATL1103. GHBP fell by a median of 23.6% and 48.8% in the once- and twice-weekly cohorts (P = 0.027 and P = 0.005) respectively. ATL1103 was well tolerated, although 84.6% of patients experienced mild-to-moderate injection-site reactions. This study provides proof of concept that ATL1103 is able to significantly lower IGF-I in patients with acromegaly.
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Affiliation(s)
- Peter J Trainer
- Department of EndocrinologyThe Christie NHS Foundation Trust, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Correspondence should be addressed to P J Trainer;
| | - John D C Newell-Price
- Department of Oncology and MetabolismThe Medical School, University of Sheffield, Sheffield, UK
- Royal Hallamshire HospitalSheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - John Ayuk
- Medicine EndocrinologyQueen Elizabeth Hospital Birmingham, Edgbaston, UK
| | | | - Aled Rees
- Neuroscience and Mental Health Research InstituteSchool of Medicine, Cardiff University, Hadyn Ellis Building, Cardiff, UK
| | - William Drake
- Department of EndocrinologySt Bartholomew’s Hospital, London, UK
| | - Philippe Chanson
- Assistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Le Kremlin-Bicêtre, France
- Inserm 1185Fac Med Paris Sud, Univ Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Thierry Brue
- Aix-Marseille UniversitéCNRS, CRN2M UMR 7286, Marseille, France
- APHMHôpital Conception, Service d’Endocrinologie, Diabète et Maladies Métaboliques, Centre de Référence des Maladies Rares d’Origine Hypophysaire, Marseille, France
| | - Susan M Webb
- Department of EndocrinologyCIBERER Group 747, IIB-S Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Carmen Fajardo
- Servicio de EndocrinologíaHospital Universitario de La Ribera, Alzira, Valencia, Spain
| | - Javier Aller
- Endocrinology DepartmentHospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain
| | - Ann I McCormack
- Garvan Institute of Medical Research and St Vincent’s HospitalDarlinghurst Sydney, New South Wales, Australia
| | - David J Torpy
- Royal Adelaide HospitalNorth Terrace, Adelaide, Australia
| | - George Tachas
- Antisense Therapeutics LimitedToorak, Victoria, Australia
| | - Lynne Atley
- Antisense Therapeutics LimitedToorak, Victoria, Australia
| | - David Ryder
- Manchester Academic Health Science Centre (MAHSC) Clinical Trials UnitThe Christie NHS Foundation Trust, University of Manchester, Manchester, UK
| | - Martin Bidlingmaier
- Endocrine LaboratoryMedizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany
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Abstract
AIMS To estimate a preference-based single index for the disease-specific instrument (AcroQoL) by mapping it onto the EQ-5D to assist in future economic evaluations. MATERIALS AND METHODS A sample of 245 acromegaly patients with AcroQoL and EQ-5D scores was obtained from three previously published European studies. The sample was split into two: one sub-sample to construct the model (algorithm construction sample, n = 184), and the other one to confirm it (validation sample, n = 61). Various multiple regression models including two-part model, tobit model, and generalized additive models were tested and/or evaluated for predictive ability, consistency of estimated coefficients, normality of prediction errors, and simplicity. RESULTS Across these studies, mean age was 50-60 years and the proportion of males was 36-59%. At overall level the percentage of patients with controlled disease was 37.4%. Mean (SD) scores for AcroQoL Global Score and EQ-5D utility were 62.3 (18.5) and 0.71 (0.28), respectively. The best model for predicting EQ-5D was a generalized regression model that included the Physical Dimension summary score and categories from questions 9 and 14 as independent variables (Adj. R2 = 0.56, with mean absolute error of 0.0128 in the confirmatory sample). Observed and predicted utilities were strongly correlated (Spearman r = 0.73, p < .001) and paired t-Student test revealed non-significant differences between means (p > .05). Estimated utility scores showed a minimum error of ≤10% in 45% of patients; however, error increased in patients with an observed utility score under 0.2. The model's predictive ability was confirmed in the validation cohort. LIMITATIONS AND CONCLUSIONS A mapping algorithm was developed for mapping of AcroQoL to EQ-5D, using patient level data from three previously published studies, and including validation in the confirmatory sub-sample. Mean (SD) utilities index in this study population was estimated as 0.71 (0.28). Additional research may be needed to test this mapping algorithm in other acromegaly populations.
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Affiliation(s)
- Xavier Badia
- a Health Economics & Outcomes Research, IMS Health , Barcelona , Spain
| | - Peter Trainer
- b The Christie NHS foundation Trust , Manchester , UK
| | - Nienke R Biermasz
- c Department of Endocrinology and Metabolism , Center of Endocrine Tumors, Leiden University Medical Center , Leiden , the Netherlands
| | - Jitske Tiemensma
- c Department of Endocrinology and Metabolism , Center of Endocrine Tumors, Leiden University Medical Center , Leiden , the Netherlands
- d Psychological Science , University of California Merced , Merced , CA , USA
| | - Agata Carreño
- a Health Economics & Outcomes Research, IMS Health , Barcelona , Spain
| | - Montse Roset
- a Health Economics & Outcomes Research, IMS Health , Barcelona , Spain
| | - Anna Forsythe
- e Global Health Economics and Market Access, Novartis Oncology , Novartis Pharmaceuticals Corporation , Hanover , NJ , USA
| | - Susan M Webb
- f Endocrinology/Medicine Departments , Hospital Sant Pau, IIB-Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER Unit 747) ISCIII, Universitat Autònoma de Barcelona (UAB) , Barcelona , Spain
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Johannsson G, Bidlingmaier M, Biller BMK, Boguszewski M, Casanueva FF, Chanson P, Clayton PE, Choong CS, Clemmons D, Dattani M, Frystyk J, Ho K, Hoffman AR, Horikawa R, Juul A, Kopchick JJ, Luo X, Neggers S, Netchine I, Olsson DS, Radovick S, Rosenfeld R, Ross RJ, Schilbach K, Solberg P, Strasburger C, Trainer P, Yuen KCJ, Wickstrom K, Jorgensen JOL. Growth Hormone Research Society perspective on biomarkers of GH action in children and adults. Endocr Connect 2018; 7:R126-R134. [PMID: 29483159 PMCID: PMC5868631 DOI: 10.1530/ec-18-0047] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 02/26/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The Growth Hormone Research Society (GRS) convened a Workshop in 2017 to evaluate clinical endpoints, surrogate endpoints and biomarkers during GH treatment of children and adults and in patients with acromegaly. PARTICIPANTS GRS invited 34 international experts including clinicians, basic scientists, a regulatory scientist and physicians from the pharmaceutical industry. EVIDENCE Current literature was reviewed and expert opinion was utilized to establish the state of the art and identify current gaps and unmet needs. CONSENSUS PROCESS Following plenary presentations, breakout groups discussed questions framed by the planning committee. The attendees re-convened after each breakout session to share the group reports. A writing team compiled the breakout session reports into a document that was subsequently discussed and revised by participants. This was edited further and circulated for final review after the meeting. Participants from pharmaceutical companies were not part of the writing process. CONCLUSIONS The clinical endpoint in paediatric GH treatment is adult height with height velocity as a surrogate endpoint. Increased life expectancy is the ideal but unfeasible clinical endpoint of GH treatment in adult GH-deficient patients (GHDA) and in patients with acromegaly. The pragmatic clinical endpoints in GHDA include normalization of body composition and quality of life, whereas symptom relief and reversal of comorbidities are used in acromegaly. Serum IGF-I is widely used as a biomarker, even though it correlates weakly with clinical endpoints in GH treatment, whereas in acromegaly, normalization of IGF-I may be related to improvement in mortality. There is an unmet need for novel biomarkers that capture the pleiotropic actions of GH in relation to GH treatment and in patients with acromegaly.
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Affiliation(s)
- Gudmundur Johannsson
- Department of Internal Medicine and Clinical NutritionSahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Martin Bidlingmaier
- Medizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, Germany
| | - Beverly M K Biller
- Neuroendocrine UnitMassachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Felipe F Casanueva
- Department of MedicineComplejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | | | - Peter E Clayton
- Developmental Biology & MedicineFaculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Catherine S Choong
- Department of EndocrinologyPrincess Margaret Hospital & School of Medicine, University of Western Australia, Western Australia, Australia
| | - David Clemmons
- Department of MedicineUniversity of North Carolina, Chapel Hill, North Carolina, USA
| | - Mehul Dattani
- Great Ormond Street Institute of Child HealthLondon, UK
| | - Jan Frystyk
- Department of EndocrinologyOdense University Hospital, Odense, Denmark
| | - Ken Ho
- Princess Alexandra Hospital and University of QueenslandBrisbane, Australia
| | - Andrew R Hoffman
- Department of MedicineStanford University and VA Palo Health Care System, Palo Alto, California, USA
| | - Reiko Horikawa
- National Center for Child Health and DevelopmentTokyo, Japan
| | - Anders Juul
- Department of Growth and ReproductionRigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - John J Kopchick
- Edison Biotechnology Institute and Heritage College of Osteopathic MedicineOhio University, Athens, Ohio, USA
| | - Xiaoping Luo
- Department of PediatricsTongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Sebastian Neggers
- Section of EndocrinologyDepartment of Medicine, Pituitary Centre Rotterdam, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Irene Netchine
- Service d'Explorations Fonctionnelles EndocriniennesAP-HP, Hôpital Trousseau, Sorbonne Université, INSERM UMRs 938, Paris, France
| | - Daniel S Olsson
- Department of EndocrinologyInstitute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sally Radovick
- Rutgers University-Robert Wood Johnson Medical SchoolNew Brunswick, New Jersey, USA
| | - Ron Rosenfeld
- Department of PediatricsOregon Health Science University, Portland, Oregon, USA
| | | | - Katharina Schilbach
- Medizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, Germany
| | - Paulo Solberg
- Universidade do Estado do Rio de JaneiroRio de Janeiro, Brazil
| | | | - Peter Trainer
- The Christie NHS Foundation TrustUniversity of Manchester, Manchester, UK
| | - Kevin C J Yuen
- Barrow Pituitary CenterBarrow Neurological Institute, Department of Neuroendocrinology, University of Arizona College of Medicine, Phoenix, Arizona, USA
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Dal J, Klose M, Heck A, Andersen M, Kistorp C, Nielsen EH, Bollerslev J, Feldt-Rasmussen U, Jørgensen JOL. Targeting either GH or IGF-I during somatostatin analogue treatment in patients with acromegaly: a randomized multicentre study. Eur J Endocrinol 2018; 178:65-74. [PMID: 28993415 DOI: 10.1530/eje-17-0546] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 09/14/2017] [Accepted: 10/04/2017] [Indexed: 11/08/2022]
Abstract
CONTEXT Discordant GH and IGF-I values are frequent in acromegaly. The clinical significance and its dependence on treatment modality and of glucose-suppressed GH (GHnadir) measurements remain uncertain. OBJECTIVE To evaluate the effects of targeting either IGF-I or GH during somatostatin analogue (SA) treatment. PATIENTS AND METHODS 84 patients with controlled acromegaly after surgery (n = 23) or SA (n = 61) underwent a GH profile including an OGTT, at baseline and after 12 months. SA patients were randomized to monitoring according to either IGF-I (n = 33) or GHnadir (n = 28). SA dose escalation was allowed at baseline and 6 months. MAIN OUTCOME MEASURES GHnadir and IGF-I at baseline and 12 months, and disease-specific Quality of Life (QoL). RESULTS IGF-I and fasting GH levels were comparable between the surgery and the SA group, whereas GHnadir (µg/L) was lower in the surgery group (GHnadir 0.7 ± 0.1 vs 0.3 ± 0.1, P < 0.01). SA dose increase was performed in 20 patients in the GH group and in 8 patients in the IGF-I group (P = 0.02), which increased the number of concordantly controlled patients (P = 0.01). QoL was only mildly affected at baseline in all groups and did not changed consistently during the study. CONCLUSION (1) Discordant values in terms of high GH levels are prevalent in SA patients and more so if applying glucose-suppressed GHnadir; (2) targeting discordant levels of either GH or IGF-I translates into SA dose increase and improved biochemical control; (3) even though QoL was not improved in this study, we suggest biochemical assessment of disease activity to include glucose-suppressed GHnadir also in SA patients.
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Affiliation(s)
- Jakob Dal
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Marianne Klose
- Department of Endocrinology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ansgar Heck
- Section of Specialized Endocrinology, Oslo University Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Marianne Andersen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | | | - Eigil H Nielsen
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Jens Bollerslev
- Section of Specialized Endocrinology, Oslo University Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ulla Feldt-Rasmussen
- Department of Endocrinology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jens O L Jørgensen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
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Mongioì LM, Condorelli RA, La Vignera S, Calogero AE. Dual-release hydrocortisone treatment: glycometabolic profile and health-related quality of life. Endocr Connect 2018; 7:211-219. [PMID: 29233815 PMCID: PMC5793805 DOI: 10.1530/ec-17-0368] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 12/12/2017] [Indexed: 12/02/2022]
Abstract
OBJECTIVE Adrenal insufficiency (AI) is a chronic condition associated with increased mortality and morbidity. The treatment of AI in the last years has been object of important changes due to the development of a dual-release preparation of hydrocortisone. It differs from previous therapeutic strategy as it contemplates a once-daily tablet that allows more closely mimicking the physiological circadian cortisol rhythm. The aim of the study was to evaluate the effects of dual-release hydrocortisone treatment on the glycometabolic profile and health-related quality of life of patients with AI. DESIGN AND METHODS In this clinical open trial, we enrolled ten patients with primary AI (41 ± 2.67 years) and nine patients with AI secondary to hypopituitarism (53.2 ± 17.7 years). We evaluated the glycometabolic profile before and 3, 6, 9 and 12 months after dual-release hydrocortisone administration. We also evaluated health-related quality of life, estimated by the AddiQol questionnaire. The mean dose administered of dual-release hydrocortisone was 28.33 ± 6.68 mg/day. RESULTS One female hypopituitary patient dropped out from the study. After 12 months of treatment, the mean dosage administered of dual-release hydrocortisone was significantly lower (P < 0.05) and all patients reported improved quality of life and well-being. The glycometabolic profile improved and the glycosylated hemoglobin decreased significantly in patients with primary AI (6.25 ± 0.2 vs 5.35 ± 0.17, P < 0.05). In contrast, hypopituitary patients had worse glycometabolic profile and a trend toward hypertriglyceridemia. CONCLUSIONS Dual-release hydrocortisone treatment improved the quality of life of patients with AI, and it allowed a decrease of cortisol dosage administered in the absence of side effects. The glycometabolic profile worsened in hypopituitary patients.
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Affiliation(s)
- L M Mongioì
- Department of Clinical and Experimental MedicineUniversity of Catania, Catania, Italy
| | - R A Condorelli
- Department of Clinical and Experimental MedicineUniversity of Catania, Catania, Italy
| | - S La Vignera
- Department of Clinical and Experimental MedicineUniversity of Catania, Catania, Italy
| | - A E Calogero
- Department of Clinical and Experimental MedicineUniversity of Catania, Catania, Italy
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GuimarãesSá AM, Ferreira PAM, Souza MT, Nascimento GC, da Silva Pereira Damianse S, de Carvalho Rocha VC, dos Santos Faria M, de Souza Paiva Ferreira A. Higher Income and Integration into the Workforce Are the Main Factors Associated with Quality of Life in Acromegalic Patients in Northeastern Brazil. Int J Endocrinol 2018; 2018:6135080. [PMID: 29681935 PMCID: PMC5848138 DOI: 10.1155/2018/6135080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 12/14/2017] [Accepted: 01/10/2018] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To identify the factors associated with quality of life in patients with acromegaly with follow-up at the referral service in neuroendocrinology of the state of Maranhão, northeast Brazil. METHODS The Acromegaly Quality of Life Questionnaire (Acro-QoL) was used. Factors independently associated with quality of life were identified using multivariate linear regression, with p values < 0.05 considered significant. RESULTS The multivariate linear regression analysis indicated a positive association between being integrated into the job market and quality of life scores in the overall domain (β = 0.288, p = 0.003), psychological domain (β = 0.291, p = 0.032), and personal relationship domain (β = 0.314, p = 0.019). We also observed a positive association with income and the quality of life scores in all domains as follows: overall domain (β = 0.037, p = 0.003), physical domain (β = 0.988, p = 0.001), psychological domain (β = 0.342, p = 0.008), physical appearance domain (β = 0.270, p = 0.049), and personal relationship domain (β = 0.315, p = 0.012). CONCLUSION For patients with acromegaly living in one of the least developed regions of Brazil, integration into the job market and a higher income were associated with a better quality of life.
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Affiliation(s)
- Adriana Maria GuimarãesSá
- Graduate Program in Public Health, Department of Public Health, The Federal University of Maranhão (UFMA), São Luís, MA, Brazil
| | | | | | - Gilvan Cortês Nascimento
- Presidente Dutra University Hospital of The Federal University of Maranhão (HUUPD-UFMA), São Luís, MA, Brazil
| | | | | | - Manuel dos Santos Faria
- Graduate Program in Child and Adult Health, Department of Medicine, UFMA, São Luís, MA, Brazil
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van der Lely AJ, Gomez R, Pleil A, Badia X, Brue T, Buchfelder M, Burman P, Clemmons D, Ghigo E, Jørgensen JOL, Luger A, van der Lans-Bussemaker J, Webb SM, Strasburger CJ. Development of ACRODAT ®, a new software medical device to assess disease activity in patients with acromegaly. Pituitary 2017; 20:692-701. [PMID: 28887782 PMCID: PMC5655576 DOI: 10.1007/s11102-017-0835-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
PURPOSE Despite availability of multimodal treatment options for acromegaly, achievement of long-term disease control is suboptimal in a significant number of patients. Furthermore, disease control as defined by biochemical normalization may not always show concordance with disease-related symptoms or patient's perceived quality of life. We developed and validated a tool to measure disease activity in acromegaly to support decision-making in clinical practice. METHODS An international expert panel (n = 10) convened to define the most critical indicators of disease activity. Patient scenarios were constructed based on these chosen parameters. Subsequently, a panel of 21 renowned endocrinologists at pituitary centers (Europe and Canada) categorized each scenario as stable, mild, or significant disease activity in an online validation study. RESULTS From expert opinion, five parameters emerged as the best overall indicators to evaluate disease activity: insulin-like growth factor I (IGF-I) level, tumor status, presence of comorbidities (cardiovascular disease, diabetes, sleep apnea), symptoms, and health-related quality of life. In the validation study, IGF-I and tumor status became the predominant parameters selected for classification of patients with moderate or severe disease activity. If IGF-I level was ≤1.2x upper limit of normal and tumor size not significantly increased, the remaining three parameters contributed to the decision in a compensatory manner. CONCLUSION The validation study underlined IGF-I and tumor status for routine clinical decision-making, whereas patient-oriented outcome measures received less medical attention. An Acromegaly Disease Activity Tool (ACRODAT) is in development that might assist clinicians towards a more holistic approach to patient management in acromegaly.
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Affiliation(s)
- Aart J van der Lely
- Erasmus University Medical Center, Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Roy Gomez
- Pfizer Medical Affairs, 17 Boulevard de la Plaine, 1050, Brussels, Belgium.
| | - Andreas Pleil
- Pfizer Inc, 10555 Science Center Drive, San Diego, CA, 92121, USA
| | - Xavier Badia
- University of Barcelona and Omakase Consulting, Gran Via de les Corts Catalanes, 585, 08007, Barcelona, Spain
| | - Thierry Brue
- Aix-Marseille Université, APHM, Hôpital Conception, Service d'Endocrinologie, Diabète et Maladies Métaboliques, Centre de Référence des Maladies Rares de l'hypophyse HYPO, 13385 Cedex 15, Marseille, France
| | - Michael Buchfelder
- Neurochirurgische Klinik, Universitatsklinikum Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Pia Burman
- Skane University Hospital, University of Lund, Jan Waldenströms gata 24, Malmö, Sweden
| | - David Clemmons
- UNC Hospitals Diabetes and Endocrinology Clinic, 300 Meadowmont Village Cir #202, Chapel Hill, NC, 27517, USA
| | - Ezio Ghigo
- University Hospital Città Salute e Scienza, Via Gianfranco Zuretti, 29, 10126, Turin, Italy
| | - Jens Otto Lunde Jørgensen
- Aarhus University, Institut for Klinisk Medicin - Medicinsk Endokrinologisk afdeling MEA, NBG, Nørrebrogade 44, 8000, Aarhus, Denmark
| | - Anton Luger
- Medizinische Universität und Allgemeines Krankenhaus Wien, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | | | - Susan M Webb
- Hospital and IIB-S Pau Barcelona, UAB and CIBERER Unit 747, Padre Claret 167, 08025, Barcelona, Spain
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Liu S, Adelman DT, Xu Y, Sisco J, Begelman SM, Webb SM, Badia X, Thethi TK, Fonseca V, Shi L. Patient-centered assessment on disease burden, quality of life, and treatment satisfaction associated with acromegaly. J Investig Med 2017; 66:653-660. [PMID: 29151042 DOI: 10.1136/jim-2017-000570] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2017] [Indexed: 11/04/2022]
Abstract
The study aimed to assess the economic burden, health-related quality of life (HRQoL), and acromegaly treatment satisfaction in the USA. A web-based, cross-sectional survey was distributed to members of Acromegaly Community. Data related to comorbidities, treatment patterns, and treatment satisfaction were collected. The costs over the past 3 months included out-of-pocket cost, sick leave, leave of absence, direct loss of job due to acromegaly, unemployment, assistance to perform household chores, and family member loss of income. The HRQoL was assessed by Acromegaly Quality of Life (AcroQoL) and EQ-5D-3L questionnaires. Among 106 patients who completed the survey (mean age: 46 years, female: 76.4%), 44.3% presented with ≥5 comorbidities, and 90.6% reporting acromegaly-related symptoms. Compared with the low-symptom group 0-3 (n=41), the 4+ symptoms group (n=65) was more likely to have depression (OR=2.3, 95% CI 1.1 to 5.2) and cardiovascular disease (OR=5.8, 95% CI 2.0 to 16.7), and experienced higher costs (loss of job: $8874 vs $1717, P=0.02; unemployment disability: $17,102 vs $429, P=0.003; household chores: $2160 vs $932, P=0.0003; family members' income loss: $692 vs $122, P=0.03). The high-symptom group had lower HRQoL scores, compared with the low-symptom group (EQ-5D-3L: 0.53 vs 0.75, P<0.0001; AcroQoL: 27 vs 56, P<0.0001). Only 55.7% among patients requiring injections for acromegaly were satisfied. Patients with acromegaly who presented with multiple acromegaly-related symptoms were evidenced to have experienced higher economic burden and poorer quality of life than patients with the same diagnosis but fewer symptoms. The low rate of treatment satisfaction warrants need for further studies.
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Affiliation(s)
- Shuqian Liu
- Department of Global Health Management and Policy, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Daphne T Adelman
- Department of Endocrinology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Yaping Xu
- US Medical Affairs, Genentech, South San Francisco, California, USA
| | - Jillone Sisco
- President, Acromegaly Community, Grove, Oklahoma, USA
| | - Susan M Begelman
- US Medical Affairs, Genentech, South San Francisco, California, USA
| | - Susan M Webb
- Endocrinology/Medicine Departments, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalunya, Spain.,Department of Endocrinology, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III, Madrid, Spain
| | - Xavier Badia
- Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III, Madrid, Spain.,Omakase Consulting and University of Barcelona, Barcelona, Spain
| | - Tina K Thethi
- Department of Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, USA
| | - Vivian Fonseca
- Department of Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, USA
| | - Lizheng Shi
- Department of Global Health Management and Policy, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
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Andela CD, Repping-Wuts H, Stikkelbroeck NMML, Pronk MC, Tiemensma J, Hermus AR, Kaptein AA, Pereira AM, Kamminga NGA, Biermasz NR. Enhanced self-efficacy after a self-management programme in pituitary disease: a randomized controlled trial. Eur J Endocrinol 2017; 177:59-72. [PMID: 28566534 DOI: 10.1530/eje-16-1015] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 03/24/2017] [Accepted: 04/19/2017] [Indexed: 01/06/2023]
Abstract
CONTEXT Patients with pituitary disease report impairments in Quality of Life (QoL) despite optimal biomedical care. Until now, the effects of a self-management intervention (SMI) addressing psychological and social issues for these patients and their partners have not been studied. OBJECTIVE To examine the effects of a SMI i.e. Patient and Partner Education Programme for Pituitary disease (PPEP-Pituitary). DESIGN AND SUBJECTS A multicentre randomized controlled trial included 174 patients with pituitary disease, and 63 partners were allocated to either PPEP-Pituitary or a control group. PPEP-Pituitary included eight weekly sessions (90 min). Self-efficacy, bother and needs for support, illness perceptions, coping and QoL were assessed before the intervention (T0), directly after (T1) and after six months (T2). Mood was assessed before and after each session. RESULTS Patients in PPEP-Pituitary reported improved mood after each session (except for session 1). In partners, mood only improved after the last three sessions. Patients reported higher self-efficacy at T1 (P = 0.016) which persisted up to T2 (P = 0.033), and less bother by mood problems directly after PPEP-Pituitary (P = 0.01), but more bother after six months (P = 0.001), although this increase was not different from baseline (P = 0.346). Partners in PPEP-Pituitary reported more vitality (P = 0.008) which persisted up to T2 (P = 0.034). At T2, partners also reported less anxiety and depressive symptoms (P ≤ 0.014). CONCLUSION This first study evaluating the effects of a SMI targeting psychosocial issues in patients with pituitary disease and their partners demonstrated promising positive results. Future research should focus on the refinement and implementation of this SMI into clinical practice.
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Affiliation(s)
- Cornelie D Andela
- Division of EndocrinologyDepartment of Medicine, and Centre for Endocrine Tumors (CETL), Leiden University Medical Centre, Leiden, The Netherlands
| | - Han Repping-Wuts
- Division of EndocrinologyDepartment of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Nike M M L Stikkelbroeck
- Division of EndocrinologyDepartment of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Mathilde C Pronk
- Division of EndocrinologyDepartment of Medicine, and Centre for Endocrine Tumors (CETL), Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Ad R Hermus
- Division of EndocrinologyDepartment of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Adrian A Kaptein
- Department of Medical PsychologyLeiden University Medical Centre, Leiden, The Netherlands
| | - Alberto M Pereira
- Division of EndocrinologyDepartment of Medicine, and Centre for Endocrine Tumors (CETL), Leiden University Medical Centre, Leiden, The Netherlands
| | - Noelle G A Kamminga
- Department of Psychiatry and Medical PsychologyMaastricht University Medical Centre, Maastricht, The Netherlands
| | - Nienke R Biermasz
- Division of EndocrinologyDepartment of Medicine, and Centre for Endocrine Tumors (CETL), Leiden University Medical Centre, Leiden, The Netherlands
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Basu A, McFarlane HG, Kopchick JJ. Spatial learning and memory in male mice with altered growth hormone action. Horm Behav 2017; 93:18-30. [PMID: 28389277 DOI: 10.1016/j.yhbeh.2017.04.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 02/13/2017] [Accepted: 04/03/2017] [Indexed: 11/17/2022]
Abstract
Growth hormone (GH) has a significant influence on cognitive performance in humans and other mammals. To understand the influence of altered GH action on cognition, we assessed spatial learning and memory using a Barnes maze (BM) comparing twelve-month old, male, bovine GH (bGH) and GH receptor antagonist (GHA) transgenic mice and their corresponding wild type (WT) littermates. During the acquisition training period in the BM, bGH mice showed increased latency, traveled longer path lengths and made more errors to reach the target than WT mice, indicating significantly poorer learning. Short-term memory (STM) and long-term memory (LTM) trials showed significantly suppressed memory retention in bGH mice when compared to the WT group. Conversely, GHA mice showed significantly better learning parameters (latency, path length and errors) and increased use of an efficient search strategy than WT mice. Our study indicates a negative impact of GH excess and a beneficial effect of the inhibition of GH action on spatial learning and memory and, therefore, cognitive performance in male mice. Further research to elucidate GH's role in brain function will facilitate identifying therapeutic applications of GH or GHA for neuropathological and neurodegenerative conditions.
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Affiliation(s)
- Amrita Basu
- Molecular and Cellular Biology Program, Edison Biotechnology Institute, Ohio University, Athens, OH, United States; Department of Biological Sciences, Edison Biotechnology Insitute, Ohio University, Athens, OH, United States.
| | | | - John J Kopchick
- Molecular and Cellular Biology Program, Edison Biotechnology Institute, Ohio University, Athens, OH, United States; Department of Biomedical Sciences, Heritage College of Osteopathic Medicine, Edison Biotechnology Institute, Ohio University, Athens, OH, United States.
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Webb SM, Crespo I, Santos A, Resmini E, Aulinas A, Valassi E. MANAGEMENT OF ENDOCRINE DISEASE: Quality of life tools for the management of pituitary disease. Eur J Endocrinol 2017; 177:R13-R26. [PMID: 28351913 DOI: 10.1530/eje-17-0041] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/07/2017] [Accepted: 03/28/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND In the last few years, quality of life (QoL) has become an outcome measure in patients with pituitary diseases. OBJECTIVE To describe the available data on QoL impairment evaluated with questionnaires in patients with pituitary diseases. DESIGN Critical review of the pertinent literature and pragmatic discussion of available information. METHODS Selection of relevant literature from PubMed and WOK, especially from the last 5 years and comprehensive analysis. RESULTS QoL is impaired in all pituitary diseases, mostly in acromegaly and Cushing's disease (similar to other causes of Cushing's syndrome), but also in non-functioning pituitary adenomas and prolactinomas, especially in the active phase of the disease. Nevertheless, even after endocrine 'cure', scores tend to be below normative values, indicative of residual morbidity after hormonal control. The presence of hypopituitarism worsens subjective QoL perception, which can improve after optimal substitution therapy, including recombinant human growth hormone, when indicated. CONCLUSIONS To improve the long-term outcome of pituitary patients, helping them to attain the best possible health, it appears desirable to include subjective aspects captured when evaluating QoL, so that the affected dimensions are identified and if relevant treated. Additionally, being aware that treatment outcome may not always mean complete normalisation of physical and mental issues related to QoL can be a first step to adaptation and conforming to this new status.
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Affiliation(s)
- Susan M Webb
- Hospital Sant PauIIB-Sant Pau, Research Center for Pituitary Diseases, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), ISCIII, and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Iris Crespo
- Hospital Sant PauIIB-Sant Pau, Research Center for Pituitary Diseases, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), ISCIII, and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Alicia Santos
- Hospital Sant PauIIB-Sant Pau, Research Center for Pituitary Diseases, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), ISCIII, and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Eugenia Resmini
- Hospital Sant PauIIB-Sant Pau, Research Center for Pituitary Diseases, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), ISCIII, and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Anna Aulinas
- Hospital Sant PauIIB-Sant Pau, Research Center for Pituitary Diseases, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), ISCIII, and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Elena Valassi
- Hospital Sant PauIIB-Sant Pau, Research Center for Pituitary Diseases, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), ISCIII, and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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Kyriakakis N, Lynch J, Gilbey SG, Webb SM, Murray RD. Impaired quality of life in patients with treated acromegaly despite long-term biochemically stable disease: Results from a 5-years prospective study. Clin Endocrinol (Oxf) 2017; 86:806-815. [PMID: 28316090 DOI: 10.1111/cen.13331] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 02/28/2017] [Accepted: 03/13/2017] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Patients with acromegaly demonstrate impaired quality of life (QoL), but data on long-term QoL changes in treated acromegaly are limited. This study evaluates and identifies factors that influence QoL in patients with long-term biochemical remission. DESIGN The study consists of a cross-sectional arm comparing QoL between patients with treated and controlled acromegaly and healthy controls; and a longitudinal arm assessing QoL changes in patients with biochemically stable disease during 5.7±0.6 years of follow-up. PATIENTS A total of 58 patients and 116 matched controls were recruited for the cross-sectional arm; 28 patients completed the longitudinal arm. MEASUREMENTS Three generic questionnaires (Psychological General Well-Being Schedule [PGWBS], 36-item Short-Form [SF-36], EuroQoL [EQ-5D]) and the disease-specific acromegaly QoL questionnaire (AcroQoL) were applied. RESULTS Quality of life assessment was performed 11.6±8.2 years following diagnosis and treatment of acromegaly. Patients with treated acromegaly had lower QoL scores compared with controls in all questionnaires with the exception of the PGWBS "Anxiety" subscale. The AcroQoL "Appearance" subscale and the "Physical Function" subscales of the remaining questionnaires were the most underscored domains. No difference in the total and subscale scores of all questionnaires was observed between baseline and follow-up, with the exception of the SF-36 "Physical Function," where a decline was found (58.5±24.7% vs 43.1±31.1%; P=.002). However, after adjusting for covariates, no significant change in any of the QoL scores was seen. Duration of IGF-1/GH control was positively correlated with QoL scores in most questionnaires at baseline, whereas use of GH lowering therapy at the time of QoL assessment was a negative predictive factor of QoL. CONCLUSION Patients with biochemically controlled acromegaly demonstrate impaired QoL, which persists despite long-term disease control. This primarily consists of impaired physical function and secondly of impaired psycho-social well-being. Duration of biochemical disease control and current use of GH lowering therapy was the predominant factors determining patients' QoL.
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Affiliation(s)
- Nikolaos Kyriakakis
- Department of Endocrinology, Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Julie Lynch
- Department of Endocrinology, Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Stephen G Gilbey
- Department of Endocrinology, Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Susan M Webb
- Endocrinology/Medicine Department, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), ISCIII; Research Center for Pituitary Diseases, Hospital Sant Pau, IIB-Sant Pau and Universitat Autònoma de Barcelona (UAB), Spain
| | - Robert D Murray
- Department of Endocrinology, Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Giustina A, Arnaldi G, Bogazzi F, Cannavò S, Colao A, De Marinis L, De Menis E, Degli Uberti E, Giorgino F, Grottoli S, Lania AG, Maffei P, Pivonello R, Ghigo E. Pegvisomant in acromegaly: an update. J Endocrinol Invest 2017; 40:577-589. [PMID: 28176221 PMCID: PMC5443862 DOI: 10.1007/s40618-017-0614-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 01/10/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND In 2007, we published an opinion document to review the role of pegvisomant (PEG) in the treatment of acromegaly. Since then, new evidence emerged on the biochemical and clinical effects of PEG and on its long-term efficacy and safety. AIM We here reviewed the emerging aspects of the use of PEG in clinical practice in the light of the most recent literature. RESULTS The clinical use of PEG is still suboptimal, considering that it remains the most powerful tool to control IGF-I in acromegaly allowing to obtain, with a pharmacological treatment, the most important clinical effects in terms of signs and symptoms, quality of life and comorbidities. The number of patients with acromegaly exposed to PEG worldwide has become quite elevated and the prolonged follow-up allows now to deal quite satisfactorily with many clinical issues including major safety issues, such as the concerns about possible tumour (re)growth under PEG. The positive or neutral impact of PEG on glucose metabolism has been highlighted, and the clinical experience, although limited, with sleep apnoea and pregnancy has been reviewed. Finally, the current concept of somatostatin receptor ligands (SRL) resistance has been addressed, in order to better define the acromegaly patients to whom the PEG option may be offered. CONCLUSIONS PEG increasingly appears to be an effective and safe medical option for many patients not controlled by SRL but its use still needs to be optimized.
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Affiliation(s)
- A Giustina
- Chair of Endocrinology, Vita-Salute San Raffaele University, Milano, Italy.
| | - G Arnaldi
- Clinic of Endocrinology and Metabolism Disease, Ospedali Riuniti di Ancona, Ancona, Italy
| | - F Bogazzi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - S Cannavò
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - A Colao
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - L De Marinis
- Pituitary Unit, Catholic University School of Medicine, Rome, Italy
| | - E De Menis
- Department of Internal Medicine, General Hospital, Montebelluna (TV), Italy
| | - E Degli Uberti
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - F Giorgino
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - S Grottoli
- Endocrinology, Diabetology and Metabolism, AOU Città della Salute e della Scienza of Turin, Turin, Italy
| | - A G Lania
- Endocrinology Unit, Department of Biomedical Sciences, Humanitas University and Humanitas Research Hospital, Rozzano, Italy
| | - P Maffei
- Department of Medicine (DIMED), 3rd Medical Clinic, Azienda Ospedaliera Padova, Padova, Italy
| | - R Pivonello
- Department of Clinical and Surgery Medicine, Endocrinology and Metabolism, University of Naples, Naples, Italy
| | - E Ghigo
- Department of Medical Sciences, School of Medicine, University of Turin, Turin, Italy
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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Affiliation(s)
- Shingo Fujio
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan
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Apezetxea A, Carrillo L, Casanueva F, de la Cuerda C, Cuesta F, Irles JA, Virgili MN, Layola M, Lizán L. Rasch analysis in the development of the NutriQoL® questionnaire, a specific health-related quality of life instrument for home enteral nutrition. J Patient Rep Outcomes 2017; 2:25. [PMID: 29888746 PMCID: PMC5976679 DOI: 10.1186/s41687-018-0050-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 04/24/2018] [Indexed: 11/18/2022] Open
Abstract
Background Home enteral nutrition (HEN) is a therapeutic method used in patients who are unable to ingest the required amounts of nutrients but retain a functional gastrointestinal tract. The objective of this study was to compose a specific questionnaire for measuring health-related quality of life (HRQoL) in HEN patients irrespective of their underlying condition and HEN route of administration. Methods Literature review, focus groups and semi-structured interviews were used to propose an initial version of the questionnaire which was answered by 165 participants. The responses were analyzed using the Rasch methodology. Firstly, the appropriateness of response options was assessed. Then, the differential item functioning (DIF) was evaluated. Finally, the item fit statistics, infit and outfit, were determined. Results Rasch analysis was performed on the responses given to the 43 items included in the initial questionnaire. Four items were excluded because more than 50% of respondents answered that the situation proposed did not apply to them. Seven items that showed overlapping and disordered categories were also removed. Pairwise DIF analysis were performed in subgroups defined by underlying disease and administration route. Eleven items presented DIF and were eliminated from the questionnaire. Finally, four items were deleted after analyzing the fit statistics, three of which did not fit the Rasch model and one did not belong to either of the dimensions. The final version of NutriQoL® includes 17 items. Conclusions NutriQoL® is a useful instrument to assess the HRQoL of HEN patients with any disease and any administration route.
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Affiliation(s)
| | - Lourdes Carrillo
- Centro de Salud Victoria de Acentejo, Santa Cruz de Tenerife, Spain
| | - Felipe Casanueva
- Department of Medicine, Universidad de Santiago de Compostela, Complejo Hospitalario Universitario de Santiago (CHUS); CIBER de Fisiopatologia Obesidad y Nutricion (CIBERobn), Instituto Salud Carlos III, Santiago de Compostela, Spain
| | | | | | | | - Maria Nuria Virgili
- Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Luis Lizán
- Outcomes'10, Universitat Jaume 1, Parc Cientific, Tecnologic i Empresarial, Edificio Espaitec 2, Campus del Riu Sec, Avenida Sos Baynat s/n, 12071 Castellon de la Plana, Castellon Spain.,Departamento de Medicina, Universidad Jaime I, Campus Riu Sec, Avenida Sos Baynat s/n, 12071 Castellón de la Plana, Spain
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50
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Fathalla H, Cusimano MD, Alsharif OM, Jing R. Endoscopic transphenoidal surgery for acromegaly improves quality of life. Can J Neurol Sci 2014; 41:735-41. [PMID: 25431207 DOI: 10.1017/cjn.2014.106] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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.
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