Wexler Tamara, Gunnell Lindsay, Omer Zehra, Kuhlthau Karen, Beauregard Catherine, Graham Gwenda, Utz Andrea L, Biller Beverly, Nachtigall Lisa, Loeffler Jay, Swearingen Brooke, Klibanski Anne, Miller Karen K
Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA.
J Clin Endocrinol Metab. 2009 Jul;94(7):2471-7. doi: 10.1210/jc.2008-2671. Epub 2009 Apr 14.
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.
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.
We conducted a cross-sectional study in a General Clinical Research Center.
Forty-five patients with prior acromegaly participated: 26 with GHD and 19 with GH sufficiency.
There were no interventions.
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.
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.
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.
生长激素缺乏症(GHD)和生长激素过多均与生活质量下降有关。然而,肢端肥大症治疗后出现GHD的患者与肢端肥大症治愈后生长激素水平正常的患者相比,生活质量是否较差尚不清楚。
本研究的目的是确定肢端肥大症治愈后出现GHD的患者与生长激素充足的患者相比,生活质量是否较差。
我们在一个综合临床研究中心进行了一项横断面研究。
45例既往有肢端肥大症的患者参与研究:26例为GHD患者,19例为生长激素充足患者。
未进行干预。
我们通过以下方式评估生活质量:1)成人生长激素缺乏症生活质量评估量表(QoL-AGHDA);2)简短健康调查问卷(SF-36);3)症状问卷。
除症状问卷中的愤怒/敌意和焦虑子量表外,所有问卷所有子量表的平均得分显示,与生长激素充足组相比,生长激素缺乏组的生活质量显著受损。生长激素释放激素-精氨酸刺激后的生长激素峰值水平与QoL-AGHDA量表得分呈负相关(R = -0.53;P = 0.0005),与症状问卷抑郁子量表得分呈负相关(R = -0.35;P = 0.031),与大多数SF-36子量表得分呈正相关。
我们的数据首次表明,与生长激素充足的患者相比,肢端肥大症治愈后出现GHD的患者生活质量降低。有必要进一步研究以确定生长激素替代疗法是否能改善肢端肥大症治愈后GHD患者的生活质量。