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

Abstract

Introduction: 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 psychologic 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: a) Quality of life using AcroQoL; b) Anxiety level with the STAI Questionnaire; c) Self-esteem by the Rosemberg Scale; and d) Facial acromegaly phenotypic changes evaluated from photographs by 8 experienced endocrinologists using a Likert scale. Results: The overall AcroQoL score showed mid-range values, with better scores for men (72.3 vs 56.6, p=0.022). AcroQoL physical domain was also higher for men (59.0 vs 34.9, p=0.006). In the psychological domain, men tended to score better (65.7 vs 54.5, p=0.069), particularly in the appearance subdimension (53.8 vs 38.8, p=0.07), while women had worse anxiety scores (p=0.009). Global self-esteem was high (2.7 ± 0.6 for a maximal value of 3), without sex differences. A trend towards a negative correlation between self-esteem and facial scores was observed (rs= -0.559, p=0.074), indicating a low psychological impact. Conclusion: In controlled acromegaly, QoL is relatively preserved in both genders, although men have better anxiety scores. Facial changes have a weak but persistent negative impact on psychological status, with greater intensity observed in women.