Morphometric changes correlate with poor psychological outcomes in patients with acromegaly

Objective: Acromegaly is frequently associatedwith altered facial appearance at the timeof diagnosis. Furthermore, acromegaly is also associatedwith 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 drawan 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-ratedmorphometric scale was highly reliable in assessing facial changes, with 93/99 (Intraclass correlation coefficient (ICC)Z0.95 (0.93-0.97)) graded as similar by independent raters. The mean (S.D.) grading for Acro and NFA patients on the clinician-ratedmorphometric scalewere 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 studydemonstratesa correlationbetweenphysical changes associatedwithacromegaly andpoorpsychological 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.