Psychological complications in patients with acromegaly: relationships with sex, arthropathy, and quality of life
Biagio Cangiano, Emanuele Maria Giusti, Caterina Premoli, Davide Soranna, Giovanni Vitale, Silvia Grottoli, Valeria Cambria, Giovanna Mantovani, Roberta Mungari, Pietro Maffei, Francesca Dassie, Antonella Giampietro, Sabrina Chiloiro, Maria Laura Tanda, Silvia Ippolito, Salvatore Cannavò, Marta Ragonese, Antonella Zambon, Luca Persani, Letizia Maria Fatti, Massimo Scacchi, on behalf of the “PRO-ACRO” study group on Motor Disability in Acromegaly, of the Italian Society of Endocrinology (SIE), Francesco Cavagnini, Diego Ferone, Sabrina Corbetta, Luigi Bartalena, Paolo Beck Peccoz, Maura Arosio, Andrea Lania, Annamaria Colao, Rosario Pivonello, Ettore C. degli Uberti, Ezio Ghigo, Andrea Giustina, Enio Martino, Alfredo Pontecorvi, Nicola Sicolo, Francesco Trimarchi
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.