*Stanisław Zgliczyński1, Piotr Woźniak2, Wojciech Zgliczyński3
Evaluation of factors affecting quality of life in acromegaly
Ocena czynników wpływających na jakość życia w akromegalii
1Students' Scientific Group "Hormon", Department of Endocrinology, Centre of Postgraduate Medical Education, Bielański Hospital, Warsaw
Head of Department: Professor Wojciech Zgliczyński, MD, PhD
2Department of Psychiatry, Bielański Hospital, Warsaw
Head of Department: Asst. Prof. Maria Załuska, MD, PhD
3Department of Endocrinology, Centre of Postgraduate Medical Education, Bielański Hospital, Warsaw
Head of Department: Professor Wojciech Zgliczyński, MD, PhD
Wstęp. Akromegalia jest to przewlekła, rzadka choroba spowodowana nadmiernym wydzielaniem hormonu wzrostu, najczęściej przez guz przysadki. Choroba prowadzi do powikłań wielonarządowych, czego wynikiem jest skrócenie średniej długości życia chorych oraz pogorszenie jego jakości.
Cel pracy. Celem pracy była ocena czynników wpływających na jakość życia w akromegalii.
Materiał i metody. Materiał stanowiło 52 chorych (29 kobiet i 23 mężczyzn) z akromegalią w wieku 25-91 lat (średnia 50,6 roku). Jakość życia oceniano przy użyciu formularza AcroQoL zawierającego trzy obszary objawów: „Objawy fizyczne”, „Wygląd zewnętrzny” oraz „Relacje społeczne”. Analizę statystyczną przeprowadzono przy użyciu programu SPSS.
Wyniki. Średni czas trwania akromegalii szacowany przez pacjentów wynosił 12,3 roku, 43 chorych leczono operacyjnie, a 6 poddano radioterapii. Wśród deklarowanych powikłań choroby zmiany zwyrodnieniowe układu kostno-stawowego występowały u 32 (62%) osób, chrapanie u 32 (62%), nadciśnienie tętnicze u 24 (46%), cukrzyca u 16 (31%), a chorobę nowotworową przebyło 8 (15%) badanych. Większość osób zgłosiła obecność więcej niż jednego z ocenianych powikłań akromegalii. Większość ankietowanych (63%) czuło się osobą chorą, z dolegliwości fizycznych najczęściej zgłaszali: zmęczenie (48%), uczucie osłabienia (40%), bóle stawów (37%), w 3/4 pacjenci byli krytyczni w stosunku do swojego wyglądu zewnętrznego.
Wnioski. W badanej grupie chorych z akromegalią: 1) czynnikami o największym wpływie na jakość życia były dolegliwości ze strony układu kostno-stawowego (bóle), oddechowego (chrapanie podczas snu) oraz zmieniony wygląd zewnętrzny; 2) nie stwierdzono wpływu choroby na relacje społeczne; 3) nie wykazano wpływu wieku pacjentów oraz długości trwania choroby na jakość życia; 4) renciści zgłaszali istotnie największe ograniczenia jakości życia z zakresu objawów fizycznych, natomiast u osób czynnych zawodowo wykazano istotnie lepszą jakość życia.
Introduction. Acromegaly is a chronic, rare disease caused by excessive secretion of growth hormone, usually by a pituitary tumor. This disease causes multisystem complications, which lead to shortened life expectancy of patients and also affect their Quality of Life.
Aim. Aim of the study was to evaluate factors influencing Quality of Life in acromegaly.
Material and methods. The material consisted of 52 patients (29 women and 23 men) with acromegaly aging from 25 to 91 (average 50.6 years old). Quality of life was evaluated with the use of AcroQoL survey which contains three symptom scales: “Physical”, “Appearance” and “Social relations”. Statistical analysis was performed using SPSS software.
Results. Average proclaimed duration of disease was 12.3 years, 43 patients had surgery, 6 underwent radiotherapy. Among declared complications, osteoarticular changes occurred in 32 (62%) patients, snoring 32 (62%), hypertension 24 (46%), diabetes 16 (31%), 8 (15%) suffered from cancer. Majority of people reported more than one disease complication. Most of respondents felt sick (63%). Frequency of physical ailments: tiredness (48%), weakness (40%), arthralgia (37%), 3/4 subjects were critical about their appearance.
Conclusions. In the studied group: 1) factors with the greatest impact on the Quality of Life were: osteoarticular complications (pain), respiratory dysfunctions (snoring) and changed appearance; 2) no disease influence on social relations was found; 3) Quality of Life was not correlated with age of patients and duration of the disease; 4) pensioners reported significantly the largest number of Quality of Life restrictions in terms of physical symptoms, while working people had significantly better Quality of Life.
Acromegaly is a chronic disease resulting from hypersecretion of growth hormone (GH). The most common cause of GH autonomic secretion is pituitary adenoma, found even in 99% patients. Other cases are related to the secretion of growth hormone-releasing hormone (GHRH) by neuroendocrine tumors (1). Acromegaly is classified as a rare disease with a prevalence of 40-70 cases per million (2). However, this number seems to be underestimated. In some foreign studies, nearly 130 cases per million are being reported (3).
Excessive secretion of GH leads to increased synthesis of insulin-like growth factor 1 (IGF-1). IGF-1 stimulates growth of soft tissues and bones, which leads to numerous complications from almost all body systems. Changes in external appearance like enlargement of face, hands and feet are also being observed in patients with acromegaly. Most of them suffer from cardiovascular, respiratory, and rheumatologic dysfunctions. All these complications lead to shortened life expectancy of patients and affect their Quality of Life (QoL) (1). Impaired QoL is mostly associated with headache and osteoarticular pain, lack of mobility affecting daily functioning, decreased libido, low self-esteem or lowered mood associated with the presence of chronic disease. Difficulties in diagnosing process can also affect patient’s QoL (4). The average delay of identifying this disease is 6-10 years (3). Acromegaly not only affect patient’s life, but also has an impact on family members (5). What is more, this disease is also associated with sleeping problems (6, 7), anxiety (8, 9), and even depression (10).
Aim of the study was to evaluate factors influencing Quality of Life in acromegaly.
Material and methods
We have collected data from a total sample of 52 patients with acromegaly under care of Endocrinology Department, Center of Postgraduate Medical Education (CMKP), Bielański Hospital, Warsaw, during 2017. We have evaluated the course of patient’s disease, its duration, occurrence of complications and treatment methods. We asked subjects about their age, marital status, education, employment and children.
QoL was evaluated with the use of AcroQoL (Acromegaly Quality of Life) questionnaire, which was specifically designed for this purpose in Spain in 2001 (11). This form contains 22 questions graduated in a 1-5 Likert-type scale, divided into two groups. In the first one severity of a given symptom was taken into account (answers: always, most of the time, sometimes, rarely, never). The second group contained respondents opinion with the presented wording (answers: completely agree, moderately agree, neither agree nor disagree, moderately disagree, completely disagree).
Questions included in AcroQoL survey are divided into three main scales. First one “Physical” (eight items) evaluates aspects like: patient’s efficiency, pain, fatigue, mood etc. Second one “Appearance” (seven items) contains questions about sense of own ugliness, changes in appearance or functioning etc. In the third one “Personal relationships” (seven items) respondents were asked, among others, about interpersonal contacts, assessment of their appearance by society and sexual problems.
The internal consistency of the AcroQoL questionnaire was evaluated in our research by calculating the Cronbach alpha (for all questions and three scales), Spearman-Brown (for equal parts) and Guttman coefficients. High values (exceeding 0.8) of all coefficients were obtained which indicates high internal consistency of the questionnaire and its subscales. The high internal coherence of the questionnaire as a whole is also indicated by the lack of a significant decrease in the value of the alpha coefficient after the removal of individual items of the scale. What is more the internal consistency of the first scale of the questionnaire (“Physical”) turned out to be clearly higher (alpha > 0.9) than the other two scales “Psychological/appearance” and “Psychological/personal relations” (alfa 0.6-0.85).
In the statistical calculations, we have used non-parametric Mann-Whitney and Kruskal-Wallis tests in order to assess intergroup differences. Correlations between individual variables were evaluated using Spearman’s rho (p < 0.01). In our sample results of the AcroQoL questionnaire were not normally distributed, which was confirmed by Kolmogorov-Smirnov test. Statistical analysis was performed using SPSS software.
The studied group consisted of 52 people aged 25-91 (average 50.6 years old, SD ± 15), 29 (56%) of them were women, and 23 (44%) men.
Most of them, 34 people (65%) had secondary education. The higher education was declared by 17 (33%) people, while primary education only by one person (2%).
In our group, 30 (58%) people were professionally active while 22 (42%) did not work. 11 (21%) subjects were on pension and 9 (17%) of them were on retirement.
32 people were married (62%), 13 of them (25%) were single, 2 subjects were divorced (4%). 37 patients (72%) had children.
Duration of the disease estimated by patients ranged from 2 to 40 years (mean 12.3 years, SD ± 8.23). 43 patients (83%) underwent pituitary gland surgery, of which 40 (93%) had one operation, two people had two (5%) and one person three (2%) operations. Six subjects (12%) underwent radiotherapy. Among declared complications of acromegaly dominated: degenerative changes of the osteoarticular system 32 (62%) and snoring 32 (62%). Twenty four (46%) patients had hypertension, 16 (31%) had type 2 diabetes mellitus (type 2 DM). 8 (15%) subjects suffered from cancer.
Most (63%) people reported the presence of more than one acromegaly complication. The most frequent of coexisting symptoms were osteoarticular changes and snoring – 37% patients (tab. 1).
Tab. 1. Coexistence of two acromegaly complications in the studied group
18 (35%) people reported the coexistence of 3 symptoms. Most frequent of these were: osteoarticular changes, snoring and hypertension – 9 people. 8 people suffered from osteoarticular changes, snoring and type 2 DM. Six patients (12%) had co-existing 4 complications of acromegaly: osteoarticular changes, snoring, hypertension and type 2 DM.
Results of the AcroQoL questionnaire were calculated by obtaining percentages according to the formula proposed by questionnaire authors (11). Total percentage results ranged from 12 to 92% (average 41% SD ± 15%).
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