Quality of life in acromegaly

Acromegaly is a disease with an important impact on health-related quality of life (HRQoL). Cross-sectional evaluation of HRQoL in patients with acromegaly using generic questionnaires and the specific questionnaire AcroQoL has confirmed severe impairment; active disease, female gender, ageing, disease duration, joint symptoms and prior radiotherapy are associated with worse HRQoL. The most affected dimension is appearance and the least affected, personal relations; comparable results have been observed in Spanish, Dutch, German, English and Turkish speaking patients. Patients with active acromegaly show a worse score (mean range 43-56) than those in remission (mean range 65-71). In longitudinal studies, in patients with stable acromegaly, no change was observed on retesting at 1 month, demonstrating a good test-retest reliability. In patients with active acromegaly, after 6 months of treatment, an improvement in the AcroQoL score was observed (56 +/- 20 to 66 +/- 18; p < 0.01). The internal consistency of AcroQoL was good (Cronbach's alpha >0.7). No correlation between AcroQoL and insulin-like growth factor-I/growth hormone levels was observed, even though a trend was found for the most affected dimension (appearance) and insulin-like growth factor-I (p = 0.051). In summary, HRQoL is severely affected in acromegaly, even in patients with controlled disease. Thus, to optimise management, not only biochemical and radiological parameters but also dimensions that reflect HRQoL should be evaluated in acromegaly.