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要旨:
INTRODUCTION: Remission criteria of acromegaly are based on biochemical
variables, i.e., normalization of increased hormone levels. However, the
established reduction in Quality of Life (QoL) is suggested to be
independent of biochemical control. The aim of this study was to test
which aspects predict QoL best in acromegaly.
METHODS/DESIGN: This is a prospective cohort study in 80 acromegalic
patients, with a cross-sectional and longitudinal part. The main outcome
measure was health-related QoL, measured by a generic and a
disease-specific questionnaire (the SF-36 and AcroQoL). Main predictors
were age, gender, biochemical control, disease characteristics,
treatment modalities, and psychopathology.
RESULTS: Our cohort of 80 acromegalics had a mean age 54.7±12.3years
with an average disease duration of 10.8±10.0years. Ratio
macro-/microadenoma was 54/26. In adjusted mixed method models, we found
that psychopathology significantly predicts QoL in acromegaly (in models
including the variables age, gender, disease duration, tumor size, basal
hormone levels, relevant treatment modalities, and relevant
comorbidities), with a higher degree of psychopathology indicating a
lower QoL (depression vs. AcroQoL: B=-1.175, p<0.001, depression vs.
SF-36: B=-1.648, p<0.001, anxiety vs. AcroQoL: B=-0.399, p<0.001,
anxiety vs. SF-36: B=-0.661, p<0.001). The explained variances
demonstrate superiority of psychopathology over biochemical control and
other variables in predicting QoL in our models.
DISCUSSION: Superiority of psychopathology over biochemical control
calls for a more extensive approach regarding diagnosing depression and
anxiety in pituitary adenomas to improve QoL. Depressive symptoms and
anxiety are modifiable factors that might provide valuable targets for
possible future treatment interventions.
