We recently developed a visual scale to assess the extent of morphometric changes in Acromegaly (Acro) patients which is strongly predictive of adverse psychological outcomes. We sought to identify if there was any association between the self-drawing test and the visual morphometric scale and if there was any correlation with psychological outcomes.
We compared 60 consecutive non-functioning adenoma (NFA) and Acro patients who had undergone pituitary surgery and/or radiation therapy (RT). Each patient was asked to draw two images: i) an image of what an average healthy body looked like, and ii) an image of what they thought their body looked like. Delta scores for right hand, right foot, height and head width were calculated for each set of drawings as percentage change based on the formula (drawing 2/drawing 1)-1)×100). We compared those scores with the grading on the morphometric scale and investigated whether the correlation could predict adverse psychological outcomes.
A total of 51 Acro and 48 NFA patients completed the study. Mean ages were 58.3 years (Acro) and 60.1 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. The delta values of Acro vs NFA were: 6.69 vs −1.62 for height (P=0.01), 47.51 vs −2.70 for right hand width (P=0.005) and 34.11 vs 8.10 for right foot size (P=0.002). Although both the self-drawing test and the morphometric grading predicted adverse psychological outcomes, different outcomes were predicted by each test. Both tests predicted cognitive dysregulation, apathy, dissatisfaction with appearance, poor personal relationships and low self-esteem. However, patients with a higher delta in the self-drawing test were significantly more likely to have affective lability, anxiousness, conduct problems, oppositionality, low affiliation and self harm whereas those with high morphometric grading were more likely to have problems with expression and appraisal. When comparing the two there was an overall positive correlation between high morphometric readings and delta scores with a significant association between width of the right hand on the drawing test and morphometric grading (P=0.02).