Background: Acromegaly (Acro) is associated with adverse psychopathological and personality outcomes despite being in remission for over a decade. We hypothesised that persistently poor psychological outcomes may be associated with morphometric changes experienced by Acro patients.
Methodology: We compared 60 consecutive non-functioning adenoma (NFA) and Acro patients who had undergone pituitary surgery and/or radiation therapy (RT). A gender-specific visual morphometric scale was developed grading patients from 0 (no obvious acromegaly changes) to 6 (advanced acromegaly changes). All patients underwent standardised photographs that were independently graded by several physicians and filled several questionnaires regarding quality of life, psychological and personality outcomes.
Results: A total of 51 Acro and 48 NFA patients completed the study. Mean ages were 58.29 years (Acro) and 60.13 years (NFA) and females constituted 54.8% (Acro) and 52.1% (NFA) (Both P=NS). Of acromegaly patients 11 were in remission without medical therapy while 37 were controlled on medical therapy. Mean morphometric scale rating in NFA was 0.41 and Acro was 3.5 (P<0.001). Patients with Acro were significantly more likely to have affective lability (P=0.04), cognitive dysregulation (P=0.025), identity disorder (P=0.04), apathy (P=0.02), poor self-esteem (P=0.01) and dissatisfaction with appearance (P<0.001). The was no association between age at diagnosis, gender, surgery, RT, hormonal dysfunction at presentation, medical therapy for acromegaly, GH and IGF-1 at presentation and recent, malignancy and psychological outcomes. However, there was a strong association between advanced morphometric changes and cognitive dysregulation, intimacy problems, restricted expression, satisfaction with personal appearance, personal relationship, self-esteem and appraisal (P=0.001 -0.04). Women were more likely to have identity problem (P=0.009) and dissatisfaction with appearance (P=0.03) while men were more likely to have conduct problem (P=0.007) and self-harm (P=0.04).
Conclusion: Our data for the first time show a strong gender-specific association between morphometric changes and adverse psychological outcomes.