Quality of life and psychological status in people with acromegaly in relation to disease-related facial changes

Abstract

Abstract: The diagnosis of acromegaly is often delayed, leading to facial disfigurements that persist despite endocrine cure. We aimed to study the relationship between facial modifications, quality of life (QoL) and psychological status in patients with acromegaly. Methods: Sixty-five patients in remission or with hormonal disease control participated (29 women and 36 men; mean age 57.4 ± 13.5 years). The following variables were assessed: i) sex; ii) QoL by AcroQoL; iii) anxiety level with the STAI questionnaire; iv) self-esteem by the Rosenberg scale; and v) facial acromegaly phenotypical changes evaluated from face photographs by eight experienced endocrinologists using a Likert scale. Results: The global AcroQoL score for the whole cohort showed mid-range values, with higher median values for men (72.3 vs 56.6, P = 0.022) mostly dependent on the physical domain, which was higher for men (59.0 vs 34.9, P = 0.006), rather than the psychological domain (65.7 vs 54.5, P = 0.069). Anxiety scores were also higher for women (7.3 vs 5.9, P = 0.009). Self-esteem state was high (2.7 ± 0.6 for a maximal value of 3) for the whole cohort without sex differences. A higher difference in the global phenotypic facial acromegaly features score from baseline and post-diagnosis was associated with a lower value on QoL mostly in women (−14.38 95% CI −5.25 to −23.52; P-value = 0.005), with less effect in men (−6.31 95% CI 0.61 to −13.22; P-value = 0.070). Conclusion: In controlled acromegaly, QoL is relatively preserved in both genders, although men have higher general and physical domain scores and lower anxiety status. Facial changes intensity negatively impacted QoL mostly in women.