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Quality of life after long-term biochemical control of acromegaly

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Abstract

Purpose

To assess long-term quality of life (QoL) in patients with sustained biochemical control of acromegaly, comparing those receiving vs not receiving pharmacotherapy (primary analysis); to assess change in QoL over time (secondary analysis).

Methods

Cross-sectional study, with a secondary longitudinal component, of 58 patients with biochemically controlled acromegaly. All had participated in studies assessing QoL years previously, after having undergone surgery ± radiotherapy. One cohort received medical therapy [MED (n = 33)]; the other did not [NO-MED (n = 25)]. QoL was assessed by the 36-Item-Short-Form Health Survey (SF-36), Acromegaly Quality of Life Questionnaire (AcroQoL), Gastrointestinal Quality of Life Index (GIQLI), Symptom Questionnaire, and QoL-Assessment of Growth Hormone Deficiency in Adults (QoL-AGHDA).

Results

Mean (± SD) duration of biochemical control was 15.0 ± 6.4 years for MED and 20.4 ± 8.2 years for NO-MED (p = 0.007). 58% of subjects scored < 25% of normal on ≥ 1 SF-36 domain and 32% scored < 25% of normal on ≥ 4 of 8 domains. Comparing MED vs NO-MED and controlling for duration of biochemical control, there were no significant differences in QoL by SF-36, AcroQOL, GIQLI, Symptom Questionnaire, or QoL-AGHDA. Growth hormone deficiency (GHD) but not radiotherapy predicted poorer QoL. In MED, QoL improved over time in three AcroQoL domains and two GIQLI domains. In NO-MED, QoL worsened in two SF-36 domains and two Symptom Questionnaire domains; QoL-AGHDA scores also worsened in subjects with GHD.

Conclusion

A history of acromegaly and development of GHD, but not pharmacologic or radiotherapy, are detrimental to QoL, which remains poor over the long-term despite biochemical control.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Funding

This work was conducted with support from The Endocrine Society Acromegaly Clinical Research Fellowship Award; NIH Grants T32 DK007028, K24 HL092902, K23DK115903, and K23 DK113220; and the Harvard Catalyst/The Harvard Clinical and Translational Science Center (Grants 1UL1TR001102, 8 UL1 TR000170 from the National Center for Advancing Translational Science, and 1 UL1 RR025758 from the National Center for Research Resources). Pfizer provided growth hormone for a randomized controlled trial from which baseline data for this study were obtained for a subset of subjects.

Author information

Author notes

  1. Kevin C. J. Yuen

    Present address: Barrow Pituitary Center, Barrow Neurological Institute, University of Arizona School of Medicine and Creighton School of Medicine, Phoenix, AZ, USA

  2. Whitney W. Woodmansee

    Present address: Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL, USA

  3. Julie L. Sharpless

    Present address: National Institutes of Health, Bethesda, MD, USA

Authors and Affiliations

  1. Neuroendocrine Unit, Massachusetts General Hospital, 55 Fruit Street, Bulfinch 457, Boston, MA, 02114, USA

    Allison Kimball, Laura E. Dichtel, Melanie S. Haines, Lisa B. Nachtigall, Nicholas A. Tritos, Anu Gerweck & Karen K. Miller

  2. Harvard Medical School, Boston, MA, USA

    Allison Kimball, Laura E. Dichtel, Whitney W. Woodmansee, Melanie S. Haines, Lisa B. Nachtigall, Brooke Swearingen, Pamela Jones, Nicholas A. Tritos, Ursula B. Kaiser & Karen K. Miller

  3. Swedish Pituitary Center, Swedish Neuroscience Institute, Seattle, WA, USA

    Kevin C. J. Yuen

  4. Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, MA, USA

    Whitney W. Woodmansee & Ursula B. Kaiser

  5. Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA

    Brooke Swearingen & Pamela Jones

  6. Department of Endocrinology, University of North Carolina, Chapel Hill, NC, USA

    Julie L. Sharpless

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  1. Allison Kimball
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by AK, LED, and KKM. The first draft of the manuscript was written by AK and all authors made comments on the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Allison Kimball.

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Conflict of interest

LED has received drug donation from Pfizer for an investigator-initiated study. WWW has participated as a clinical trial investigator for Chiasma. LBN has received grant support/investigator funding from Ipsen and Chiasma and serves as a consultant on an advisory board for Pfizer and Chiasma. BS has equity in Pfizer and Amgen. UBK served as a consultant on advisory boards for Novo Nordisk and Acerus. KKM has received grant support for investigator-initiated studies from Amgen and drug donation from Pfizer for an investigated-initiated study and has equity in GE, Bristol-Myers Squibb, Becton Dickinson, and Boston Scientific. The other authors have no conflicts of interest to disclose.

Ethical approval

Approval was obtained from the Massachusetts General Hospital Institutional Review Board. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

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Kimball, A., Dichtel, L.E., Yuen, K.C.J. et al. Quality of life after long-term biochemical control of acromegaly. Pituitary 25, 531–539 (2022). https://doi.org/10.1007/s11102-022-01224-0

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