Endocrine Abstracts

Introduction: Acromegaly patients (ACRO) show increased morbidity that affects health and quality of life (QoL). Elderly ACRO are going to increase in the next few years, but evidence regarding their management is lacking.

Aim: To evaluate physical, functional and cognitive performances of elderly ACRO and the relationship with QoL.

Methods: Multicenter case-control study conducted on 42 older ACRO (≥ 65 years) compared to an age- and gender-matched control group (CTR). Each patient underwent a multidimensional geriatric evaluation. QoL was tested with SF-36 questionnaire.

Results: Mean age in both groups was 73 ± 6 years and female gender was most represented (69%). 13 ACRO were in remission and 29 had active disease controlled by medical therapy except for one patient. ACRO showed worse mobility skills, poorer functional status assessment and lower cognitive evaluation scores than CTR (P<0.05). Age negatively correlated with mobility skills, instrumental and basic daily activities execution (IADL and BADL) and cognitive performance in ACRO (P<0.05). ACRO presented less satisfactory scores in 5 out of 8 SF-36 questionnaire domains as compared to CTR: physical activity (PA), physical pain (PP), general health (GH), vitality (V), social activities (SA) (P<0.05). PA, V and SA scores worsened with the increasing number of drugs and comorbidities (P<0.01). Increasing BMI positively correlated with better PA scores, but no associations were found between BMI and mobility skills. In ACRO, better mobility, IADL, BADL and cognitive performances correlated with more satisfactory PA, PP, GH, V and SA scores (P<0.01). Mobility skills, BADL, IADL and cognitive evaluation strongly correlated with all 8 SF-36 domains in ACRO (P<0.01). Conversely, no correlations were found in CTR. All comorbidities were more frequent in ACRO than CTR. Musculoskeletal and bone diseases were more frequent in ACRO than in CTR (52% vs. 12%; 64% vs. 10%; P< 0.05) and independently associated with geriatric outcomes in ACRO.

Conclusions: Elderly ACRO show worse performance in mobility skills, functional and cognitive status as compared to no acromegaly patients, supporting increased frailty worsening with aging. Poorer geriatric outcomes directly affect many aspects of QoL and health self-perception. A major prevalence of comorbidities in ACRO group might explain these discrepancies. Our data support the inclusion of a multidimensional geriatric evaluation in routine clinical practice to improve elderly ACRO management and, consequently, ACRO QoL. Further studies are needed to identify the most appropriate geriatric tools.