Search

Purpose: The impact of GH/IGF-1 levels on skeletal muscle in acromegaly is still controversial. Temporal (TMT) and masseter muscle (MMT) thickness has been recently demonstrated as a reliable measure of muscle mass. We aimed to investigate the relationship between TMT, MMT and clinical/biochemical characteristics in patients with acromegaly., Methods: Single center retrospective longitudinal study including 69 patients with at least one available brain/sella turcica MRI and matched clinical data. TMT, MMT, and muscle fatty infiltration (modified Goutallier score) were evaluated in all patients at baseline (first available MRI) and over time (182 MRIs analyzed)., Results: At baseline, both TMT and MMT were higher in males than females (p = 0.001 and p = 0.016, respectively). TMT and MMT were positively associated (β 0.508, p < 0.001), and they were positively correlated with IGF-1 xULN (TMT, p = 0.047; MMT, p = 0.001). MMT had a positive correlation with patients' weight (p = 0.015) and height (p = 0.006). No correlation was found between TMT, MMT and the presence of hypogonadism. Considering all available MRIs, sex and IGF-1 xULN were significant determinants of TMT and MMT at multivariable analysis (female sex: β -0.345/-0.426, p < 0.001; IGF-1 xULN: β 0.257/0.328, p < 0.001). At longitudinal evaluation, uncontrolled patients at baseline showed a significant reduction of MMT over time (p = 0.044). Remarkable fatty infiltration was observed in 34-37% of MRIs; age was the main determinant (temporal muscle: OR 1.665; p = 0.013; masseter muscle: OR 1.793; p = 0.009)., Conclusion: Male patients with higher IGF-1 values have thicker temporal and masseter muscles, suggesting that sex and IGF-1 have a significant impact on muscle mass in acromegaly., (© 2024. The Author(s).)

Active wearable devices such as protective smart belts have been proposed to reduce hip impact in the event of a fall. This study primarily evaluated the feasibility and acceptance of a specific protective belt among selected patients identified as being at risk of falling who were admitted to an ICS Maugeri Neurorehabilitation Unit from September 2022 to April 2023. According to previous institutional observations, the device was worn between the 6th and 21st days of recovery. Out of 435 admitted patients, 118 were considered eligible, but 101 declined to participate (about 50% refused to wear the belt without first trying it on; the other 50% found it too heavy or difficult to manage). Among the 17 patients who accepted (users), 9 used the belt correctly. The remaining eight patients refused to wear it after 24 h, due to discomfort. Out of 435 patients admitted, we observed at least one fall in 49 patients, of whom 5 were eligible patients; 1 was a user who had quickly refused to use the belt and fell with mild damage. Two non-eligible patients and one eligible non-user patient experienced falls resulting in hip fractures; only in the latter case could the use of the belt have limited the damage to the hip. Difficulties in recruiting patients and low acceptance of the proposed intervention present further challenges., Competing Interests: The authors declare no conflicts of interest.

Context: Patients with acromegaly are characterized by chronic exposure to high growth hormone (GH) and insulin-like growth factor-1 levels, known for their anabolic effect on skeletal muscle. Therefore, an increased skeletal muscle mass could be hypothesized in these individuals. Herein, we have performed a systematic revision of published evidence regarding skeletal muscle mass, quality, and performance in patients with acromegaly., Evidence Acquisition: A systematic review of the literature in the PubMed database up to September 1, 2023, was conducted with the following query: acromegaly AND ("muscle mass" OR "skeletal muscle"). We excluded studies that did not compare different disease states or used nonradiological methods for the skeletal muscle analyses, except for bioelectrical impedance analysis., Evidence Synthesis: Fifteen studies met the inclusion criteria. A total of 360 patients were evaluated for skeletal muscle mass, 122 for muscle fatty atrophy, and 192 for muscle performance. No clear evidence of increased skeletal muscle mass in patients with active disease compared to control or healthy individuals emerged. As for skeletal muscle quality, we observed a trend toward higher fatty infiltration among patients with acromegaly compared to healthy participants. Likewise, patients with active disease showed consistently worse physical performance compared to control or healthy individuals., Conclusion: Skeletal muscle in acromegaly has lower quality and performance compared to that of healthy individuals. The small number of published studies and multiple confounding factors (eg, use of different radiological techniques) contributed to mixed results, especially regarding skeletal muscle mass. Well-designed prospective studies are needed to investigate skeletal muscle mass in patients with acromegaly., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society.)

Background: The International Classification of Functioning, Disability, and Health (ICF) is growing in importance in cardiac rehabilitation (CR) as the number of elderly comorbid patients increases., Aim: To classify through the ICF framework a group of post-cardiac surgery (CS) and chronic heart failure (CHF) patients undergoing rehabilitation. Then, to compare the two groups and identify possible factors at admission that could affect ICF evaluations at discharge., Design: Observational retrospective real-life study., Setting: Two inpatient CR units., Population: Consecutive CS and CHF patients admitted for CR (January-December 2019)., Methods: Clinical, anthropometric data and functional status at admission and discharge were extracted from patient health records. A set of 26 ICF codes regarding body functions (b) and activities (d) was analyzed to identify: 1) the qualifiers attributed (from 0=no impairment to 4=severe impairment) for each code, 2) the percent distribution of qualifiers (0/1/2/3/4) attributed per patient. We then evaluated changes in both (1) and (2 - defined as ICF Delta%) from admission to discharge., Results: All patients (55% males; mean age 73±12 years) showed an improvement post-rehabilitation in the ICF qualifiers attributed (P<0.0001 for all codes). CS patients (N.=150) were less functionally impaired at admission than CHF (N.=194) (P<0.05 for all codes), and at discharge showed greater Delta% in the qualifiers 0/1/2 attributed than CHF (P<0.0001 for b codes; P<0.05 for d codes). Delta% for qualifiers 3 and 4 was similar in the two groups. No impairment at admission (qualifier 0), CS group, and presence/complexity of comorbidities were identified as possible covariates influencing ICF qualifiers at discharge, impacting the rate of both no/mild impairment (ICF% aggregate 0+1 - adjusted R 2 =0.627; P<0.0001) and moderate impairment (ICF% qualifier 2 - adjusted R 2 =0.507; P<0.0001)., Conclusions: CHF patients showed a worse ICF picture at admission and less improvement at discharge than CS. The presence and complexity of comorbidities negatively influenced the ICF classification at discharge, especially in CHF patients., Clinical Rehabilitation Impact: This study shows the utility of ICF classification in CR as a means for describing, measuring, and comparing patient functioning across the care continuum.

Although GH and IGF-1 excess has a controversial impact on bone mineral density (BMD), acromegalic patients display variable degrees of bone structure impairment. In this study, we aim to investigate the usefulness of trabecular bone score (TBS), compared to BMD, in identifying acromegalic patients with impaired lumbar spine trabecular microarchitecture. Forty-four acromegalic patients were investigated for disease control, metabolic and gonadal status, bone metabolism parameters, and the presence of vertebral fractures (VFs). Patients and matched healthy controls underwent BMD and TBS examination. Mean TBS values were lower in patients than in controls (p < 0.001), without significant differences in mean lumbar and femoral BMD. TBS values were significantly higher in controlled patients compared to the uncontrolled ones (p = 0.012). No significant differences were found in bone markers with respect to disease control. Mean TBS or lumbar BMD did not significantly differ in patients with or without VFs (prevalence 11.4%). TBS and BMD levels were lower in hypogonadal patients compared to the eugonadal ones (p = 0.030 and p < 0.001, respectively). In conclusion, TBS values are significantly lower in patients than in controls, confirming the presence of impaired lumbar spine trabecular bone in acromegaly. Both uncontrolled disease and hypogonadism contribute to TBS deterioration in acromegaly.

Purpose: Acromegaly is a severe chronic endocrine disease. Achieving biochemical control often needs a multimodal treatment approach, including prolonged medical treatment. Aim of the study is to evaluate the burden of treatment direct costs with respect to the different therapeutic strategies, disease control, and follow-up length., Methods: Single center retrospective study on 73 acromegaly patients. Costs of acromegaly treatments were computed based on a detailed revision of patients' clinical charts., Results: Median total treatment cost/patient was €47,343 during the entire follow-up (8 years), while median treatment cost/patient/year was €6811. The majority of patients received medical therapy (71/73, 97.3%). Median cost for first-line medical treatment (first-generation somatostatin receptor ligands) was lower compared to second-line treatments (pegvisomant monotherapy or combination therapies), considering both total (€22,824 vs €76,140; p < 0.001), and yearly cost/patient (€4927 vs €9161; p < 0.001). Sixty patients (82.2%) reached biochemical control at last follow-up (IGF-1 ≤ 1 xULN). The percentage of patients treated with first- or second-line medical therapies was comparable between controlled and uncontrolled patients (p = 1.000), and the yearly cost/patient did not significantly differ between the two groups (€6936 vs €6680; p = 0.829). Follow-up duration was significantly longer in controlled patients compared to the uncontrolled ones (8.7 vs 3.5 years; p = 0.019)., Conclusions: Direct costs for the management of acromegaly have a significant burden on the healthcare systems. However, more than 80% of our patients reached biochemical control using multimodal approaches. Treatment modalities and yearly costs did not significantly differ between controlled and uncontrolled patients, while follow-up length represented a major determinant of biochemical outcome., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: To compare disability changes measured with the Respiratory ICF Maugeri core set on COPD patients, recovering from acute exacerbation with and without hospitalization, submitted to pulmonary rehabilitation (PR)., Materials and Methods: All COPD inpatients admitted for rehabilitation in 9 Respiratory Units (January-August 2019) were considered eligible. 2066 patients were included (540 discharged from an acute Hospital = Hospital group and 1526 coming from their home = Home group). Healthcare professionals filled, in a digitalized chart, the Respiratory ICF Maugeri core set (26 items), assessing ICF categories at admission and discharge., Results: The baseline distribution of the more severe ICF qualifiers was higher in the Hospital group ( p  < .001) when compared to the Home group. After rehabilitation, all patients -irrespective of hospitalization need- statistically decreased the rate of the higher ICF qualifiers ( p  < .0001). Hospital group improved more both the rate of qualifiers ≥2 [Δ: -21.32 (22.41) vs -15.48 (17.32), p  < .001] and the rate of qualifiers 0-1 [Δ: + 18.38 (24.67) vs 13.25 (19.13), p  < .001] than Home group., Conclusions: Disability measured with the "Respiratory ICF Maugeri core set" after PR improves in COPD patients recovering from acute exacerbation irrespective of hospitalization need. Its use an additional outcome remains to be further elucidated.KEY MESSAGESRoutine implementation of an ICF set for chronic respiratory diseases can enhance a patient-centered approach in rehabilitation for different severity conditions.Pulmonary rehabilitation (PR) seems to improve global disability measured with the Respiratory ICF Maugeri core set in COPD patients recovering from acute exacerbation irrespective of hospitalization need, suggesting the use of ICF set as additional PR outcome.The description, through the ICF language, of rehabilitative needs of patients, coming "from-Home" and "from-Hospital" settings, could help staff and instrument organization.