title: Health Outcomes in Acromegaly: Depression and Anxiety are Promising Targets for Improving Reduced Quality of Life.
abstract: BACKGROUND
  Remission criteria of acromegaly are based on biochemical variables, i.e., normalization of increased hormone levels. However, the established reduction in Quality of Life (QoL) is suggested to be independent of biochemical control. The aim of this study was to test which aspects predict QoL best in acromegaly.
  
  
  METHODS
  This is a prospective cohort study in 80 acromegalic patients, with a cross-sectional and longitudinal part. The main outcome measure was health-related QoL, measured by a generic and a disease-specific questionnaire (the SF-36 and AcroQoL). Main predictors were age, gender, biochemical control, disease characteristics, treatment modalities, and psychopathology.
  
  
  RESULTS
  Our cohort of 80 acromegalics had a mean age 54.7 ± 12.3 years with an average disease duration of 10.8 ± 10.0 years. Ratio macro-/microadenoma was 54/26. In adjusted mixed method models, we found that psychopathology significantly predicts QoL in acromegaly (in models including the variables age, gender, disease duration, tumor size, basal hormone levels, relevant treatment modalities, and relevant comorbidities), with a higher degree of psychopathology indicating a lower QoL (depression vs. AcroQoL: B = -1.175, p < 0.001, depression vs. SF-36: B = -1.648, p < 0.001, anxiety vs. AcroQoL: B = -0.399, p < 0.001, anxiety vs. SF-36: B = -0.661, p < 0.001). The explained variances demonstrate superiority of psychopathology over biochemical control and other variables in predicting QoL in our models.
  
  
  CONCLUSIONS
  Superiority of psychopathology over biochemical control calls for a more extensive approach regarding diagnosing depression and anxiety in pituitary adenomas to improve QoL. Depressive symptoms and anxiety are modifiable factors that might provide valuable targets for possible future treatment interventions.
authors.affiliation: Max Planck Institute of Psychiatry , Munich , Germany ; Leiden University Medical Center , Leiden , Netherlands.
authors.forename: Victor Jacobus
authors.initials: VJ
authors.lastname: Geraedts
authors.affiliation: Max Planck Institute of Psychiatry , Munich , Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Dimopoulou
authors.affiliation: Max Planck Institute of Psychiatry , Munich , Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Auer
authors.affiliation: Medizinische Klinik Innenstadt, Ludwig-Maximilians University , Munich , Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Schopohl
authors.affiliation: Max Planck Institute of Psychiatry , Munich , Germany.
authors.forename: Günter Karl
authors.initials: GK
authors.lastname: Stalla
authors.affiliation: Max Planck Institute of Psychiatry , Munich , Germany.
authors.forename: Caroline
authors.initials: C
authors.lastname: Sievers
keywords: acromegaly; anxiety; biochemical control; depression; pituitary adenomas; quality of life