Growth hormone deficiency is associated with decreased quality of life in patients with prior acromegaly

Abstract

Context: Both GH deficiency (GHD) and GH excess are associated with a decreased quality of life. However, it is unknown whether patients with GHD after treatment for acromegaly have a poorer quality of life than those with normal GH levels after cure of acromegaly.

Objective: The aim of the study was to determine whether patients with GHD and prior acromegaly have a poorer quality of life than those with GH sufficiency after cure of acromegaly.

Design and setting: We conducted a cross-sectional study in a General Clinical Research Center.

Study participants: Forty-five patients with prior acromegaly participated: 26 with GHD and 19 with GH sufficiency.

Intervention: There were no interventions.

Main outcome measures: We evaluated quality of life, as measured by 1) the Quality of Life Adult Growth Hormone Deficiency Assessment (QoL-AGHDA); 2) the Short-Form Health Survey (SF-36); and 3) the Symptom Questionnaire.

Results: Mean scores on all subscales of all questionnaires, except for the anger/hostility and anxiety subscales of the Symptom Questionnaire, showed significantly impaired quality of life in the GH-deficient group compared with the GH-sufficient group. Peak GH levels after GHRH-arginine stimulation levels were inversely associated with QoL-AGHDA scale scores (R = -0.53; P = 0.0005) and the Symptom Questionnaire Depression subscale scores (R = -0.35; P = 0.031) and positively associated with most SF-36 subscale scores.

Conclusions: Our data are the first to demonstrate a reduced quality of life in patients who develop GHD after cure of acromegaly compared to those who are GH sufficient. Further studies are warranted to determine whether GH replacement would improve quality of life for patients with GHD after cure from acromegaly.

Figure 1

Mean (±sem) AGHDA scores were higher in the GH-deficient than GH-sufficient subjects with prior acromegaly. Black bar, GH-deficient; gray bar, GH-sufficient. *, P = 0.0002. Higher scores on the AGHDA indicate poorer quality of life.

Figure 2

Mean (±sem) Symptom Questionnaire scores were higher for all subscales, except for anxiety and anger/hostility, in the GH-deficient than GH-sufficient subjects with prior acromegaly. Black bars, GH-deficient; gray bars, GH-sufficient. *, P < 0.05. Higher scores on the Symptom Questionnaire indicate poorer quality of life.

Figure 3

Mean (±sem) SF-36 scores were lower for all subscales in the GH-deficient than GH-sufficient subjects with prior acromegaly. Black bars, GH-deficient; gray bars, GH-sufficient; whiskers, normal ranges. *, P < 0.03. Lower scores on the SF-36 questionnaire indicate poorer quality of life.

Figure 4

Peak GH levels after GHRH-arginine stimulation levels were inversely associated with QoL-AGHDA scale scores. Higher scores on the AGHDA indicate poorer quality of life.