Endocrine Abstracts

Background: Psychopathological distress is a significant burden in acromegaly, mostly in terms of depression and anxiety. Patients are also reported to experience an impairment in cognitive performance, yet literature is highly heterogeneous.

M&M: We conducted a cross-sectional study recruiting 44 acromegalic patients (59% females, 29.5% with active disease, 70.5% controlled/in remission) referring to our tertiary center between 2011 and 2023 and 40 healthy controls matched for sex, age, and educational level. We explored the psychological status through Beck-Depression-Inventory-II (BDI) and State-Trait-Anxiety-Inventory X1 and X2 (STAI X1-X2) and 12 standardized tests exploring different neuropsychological areas (short- and long-term verbal and visuo-spatial memory, selective attention, attentional shifting, verbal fluencies, inhibitory functions, constructional praxis, deductive reasoning and perseverative behavior). Moreover, we performed a prospective analysis of a subgroup of 9 patients recruited at diagnosis and followed-up for 10 years. Both functions were assessed at four time-points: T1) before surgery; T2) 3 days post-operatively; T3) 12 months after and T4) 10 years after surgery.

Results: In cross-sectional study, 10 patients (22.7%) reported a pathological score indicative of depression at BDI, 50% of whom with active disease (P=0.13). Focusing on anxiety, 6 male patients (33.5%) scored pathologically at STAI-X1 and no female; 66% of them with active disease (P=0.05). Mean results of STAI-X2 indicated a slight overall trait anxiety (52.22±17.96), with 7 patients (38.9%) reporting a pathological score (6 females); most of them (71%) with active disease (P=0.017). We indeed found an association between IGF-1 levels and STAI-X1 and STAI-X2 (P=0.010 and P=0.008, respectively) and between age and STAI-X1 and STAI-X2 (P=0.046 and 0.042, respectively). Considering cognitive function, mean results of both patients and controls resulted within the respective ranges of normality, yet the number of patients scoring pathologically was significantly higher vs controls, showing a deterioration in all domains explored except for constructional apraxia. No differences were found among pathological results and disease status or pituitary deficits, except for auditory learning (RAVLT-Immediate) and long-term verbal memory and (RAVLT-long-term), with hypopituitaric patients performing worse (P=0.01 and P=0.01 respectively). IGF-1 levels positively correlated only with the results of Corsi test indagating short term visuospatial memory (P=0.014). At prospective analysis, we registered an overall improving trend in neurocognitive performance scores over the follow-up period, especially from diagnosis to T3.

Conclusion: Our data confirmed the presence of psychological symptoms in acromegaly. We underlined the relation between active disease and cognitive impairment with a possible improvement after disease control.