title: Morphometric changes correlate with poor psychological outcomes in patients with acromegaly.
abstract: OBJECTIVE
  Acromegaly is frequently associated with altered facial appearance at the time of diagnosis. Furthermore, acromegaly is also associated with adverse psychological outcomes. We conducted a single-centre, cross-sectional study comparing patients with growth hormone vs non-functioning pituitary adenomas (NFA) to assess the association between morphometric changes and psychological outcomes and illness perception of patients with acromegaly.
  
  
  METHODS
  A seven-step scale was developed to grade morphometric changes based on facial photographs. In addition, all patients were asked to draw an image of their own body and an image of what they considered to be an average healthy body and complete seven psychological questionnaires. We recruited 55 consecutive patients in each of the two groups who had undergone surgery with or without radiation therapy (RT).
  
  
  RESULTS
  Our data showed that the clinician-rated morphometric scale was highly reliable in assessing facial changes, with 93/99 (Intraclass correlation coefficient (ICC)=0.95 (0.93-0.97)) graded as similar by independent raters. The mean (s.d.) grading for Acro and NFA patients on the clinician-rated morphometric scale were 3.5 (1.3) and 0.41 (0.35) respectively (P<0.0001). A higher clinician-rated morphometric score was also predictive of a poorer score on the drawing test.
  
  
  CONCLUSIONS
  Our study demonstrates a correlation between physical changes associated with acromegaly and poor psychological outcomes, whereas no such correlation existed with modes of therapy, disease control status, RT, malignancy, initial or recent GH/IGF1 or secondary hormonal deficiency. Our data support the utility of the morphometric scale as a clinical tool for grading facial changes.
authors.forename: Syed Ali
authors.initials: SA
authors.lastname: Imran
authors.affiliation: Dalhousie University6299 South Street, Halifax, Nova Scotia, Canada B3H 4R2SSHAPsychological Science, University of California, Merced, 5200 North Lake Road, Merced, California 95343, USA.
authors.forename: Jitske
authors.initials: J
authors.lastname: Tiemensma
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Kaiser
authors.forename: Michael
authors.initials: M
authors.lastname: Vallis
authors.forename: Steve
authors.initials: S
authors.lastname: Doucette
authors.forename: Ebad
authors.initials: E
authors.lastname: Abidi
authors.forename: Churn-Ern
authors.initials: CE
authors.lastname: Yip
authors.forename: Barna
authors.initials: B
authors.lastname: De Tugwell
authors.forename: Ferhan
authors.initials: F
authors.lastname: Siddiqi
authors.forename: David B
authors.initials: DB
authors.lastname: Clarke
mesh_terms: D000172:Acromegaly / Q000097:blood / Q000473:pathology* / Q000523:psychology*; D000236:Adenoma / Q000473:pathology; D000328:Adult; D000368:Aged; D001828:Body Image; D003430:Cross-Sectional Studies; D005145:Face; D005260:Female; D005951:Glucose Tolerance Test; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000473:pathology; D019382:Human Growth Hormone / Q000097:blood; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008297:Male; D008875:Middle Aged; D009674:Nova Scotia; D010781:Photography; D010911:Pituitary Neoplasms / Q000473:pathology; D011788:Quality of Life; D012649:Self Concept; D012737:Sex Factors; D012944:Social Support; D011795:Surveys and Questionnaires
chemical_list: D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I