Long-term facial changes and clinical correlations in patients with treated acromegaly: a cohort study

in European Journal of Endocrinology
View More View Less
  • 1 Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  • 2 Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

Correspondence should be addressed to X Long or B Xing; Email: pumclongxiao@126.com or xingb@pumch.cn
Restricted access

Background

Facial abnormality is the most significant feature in acromegaly patients. However, it is unclear whether and how patient facial appearance improves after treatment. This study aimed to identify 3D facial changes in acromegaly patients after surgical treatment.

Methods

This study included 30 acromegaly patients who underwent resection of a pituitary GH adenoma. The location and extent of facial changes were identified by comparing baseline and 2-year follow-up 3D images of the face. Relationships between facial changes and GH and IGF-1 were evaluated with simple or multivariable linear regression models.

Results

Significant soft tissue improvements were observed in acromegaly patients with complete remission, especially in the nose and lip region. Significant reductions in nasal width (3.46 mm, P < 0.001), tip protrusion (1.18 mm, P = 0.003), face curve length (3.89 mm, P = 0.004) and vermilion area (1.42 cm3, P = 0.001) were observed at the 2-year follow-up. Further, changes in nasal width were associated with decreases in GH (β = 4.440, P = 0.017), the GH nadir (β = 4.393, P = 0.011) and IGF-1 (β = 5.263, P = 0.002). The associations were maintained after adjusting for confounders.

Conclusions

Acromegaly patients achieved considerable facial improvements after surgical treatment. The change in nose width was associated with GH and IGF-1 decrease. Better control of patient hormone levels after surgery improves patient facial recovery.

 

     European Society of Endocrinology

Sept 2018 onwards Past Year Past 30 Days
Abstract Views 112 112 112
Full Text Views 16 16 16
PDF Downloads 12 12 12
  • 1

    Katznelson L, Laws ER, Melmed S, Molitch ME, Murad MH, Utz A, Wass JAHEndocrine Society. Acromegaly: an Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism 2014 99 39333951. (https://doi.org/10.1210/jc.2014-2700)

    • Search Google Scholar
    • Export Citation
  • 2

    Matta MP, Couture E, Cazals L, Vezzosi D, Bennet A & Caron P Impaired quality of life of patients with acromegaly: control of GH/IGF-I excess improves psychological subscale appearance. European Journal of Endocrinology 2008 158 305310. (https://doi.org/10.1530/EJE-07-0697)

    • Search Google Scholar
    • Export Citation
  • 3

    Vilar L, Vilar CF, Lyra R, Lyra R & Naves LA Acromegaly: clinical features at diagnosis. Pituitary 2017 20 2232. (https://doi.org/10.1007/s11102-016-0772-8)

    • Search Google Scholar
    • Export Citation
  • 4

    Ip MS, Tan KC, Peh WC & Lam KS Effect of Sandostatin LAR on sleep apnoea in acromegaly: correlation with computerized tomographic cephalometry and hormonal activity. Clinical Endocrinology 2001 55 477483. (https://doi.org/10.1046/j.1365-2265.2001.01358.x)

    • Search Google Scholar
    • Export Citation
  • 5

    Colao A, Marzullo P, Vallone G, Marino V, Annecchino M, Ferone D, De Brasi D, Scarpa R, Oriente P & Lombardi G Reversibility of joint thickening in acromegalic patients: an ultrasonography study. Journal of Clinical Endocrinology and Metabolism 1998 83 21212125. (https://doi.org/10.1210/jcem.83.6.4865)

    • Search Google Scholar
    • Export Citation
  • 6

    Wei R, Jiang C, Gao J, Xu P, Zhang D, Sun Z, Liu X, Deng K, Bao X & Sun G et al. Deep-learning approach to automatic identification of facial anomalies in endocrine disorders. Neuroendocrinology 2020 110 328337. (https://doi.org/10.1159/000502211)

    • Search Google Scholar
    • Export Citation
  • 7

    Schneider HJ, Kosilek RP, Gunther M, Roemmler J, Stalla GK, Sievers C, Reincke M, Schopohl J & Wurtz RP A novel approach to the detection of acromegaly: accuracy of diagnosis by automatic face classification. Journal of Clinical Endocrinology and Metabolism 2011 96 20742080. (https://doi.org/10.1210/jc.2011-0237)

    • Search Google Scholar
    • Export Citation
  • 8

    Heike CL, Upson K, Stuhaug E & Weinberg SM 3D digital stereophotogrammetry: a practical guide to facial image acquisition. Head and Face Medicine 2010 6 18. (https://doi.org/10.1186/1746-160X-6-18)

    • Search Google Scholar
    • Export Citation
  • 9

    Guo X, Meng T, Huang J, Wang X, Lian W, Deng K, Gao L, Wang Z, Xing B & Long X 3D facial analysis in acromegaly: gender-specific features and clinical correlations. Frontiers in Endocrinology 2018 9 722. (https://doi.org/10.3389/fendo.2018.00722)

    • Search Google Scholar
    • Export Citation
  • 10

    Melmed S, Casanueva FF, Klibanski A, Bronstein MD, Chanson P, Lamberts SW, Strasburger CJ, Wass JA & Giustina A A consensus on the diagnosis and treatment of acromegaly complications. Pituitary 2013 16 294302. (https://doi.org/10.1007/s11102-012-0420-x)

    • Search Google Scholar
    • Export Citation
  • 11

    Melmed S, Bronstein MD, Chanson P, Klibanski A, Casanueva FF, Wass JAH, Strasburger CJ, Luger A, Clemmons DR & Giustina A A consensus statement on acromegaly therapeutic outcomes. Nature Reviews: Endocrinology 2018 14 552561. (https://doi.org/10.1038/s41574-018-0058-5)

    • Search Google Scholar
    • Export Citation
  • 12

    Zhang Y, Guo X, Pei L, Zhang Z, Tan G & Xing B High levels of IGF-1 predict difficult intubation of patients with acromegaly. Endocrine 2017 57 326334. (https://doi.org/10.1007/s12020-017-1338-x)

    • Search Google Scholar
    • Export Citation
  • 13

    Farkas LG Anthropometry of the Head and Face, 2nd ed. Raven Press, 1994.

  • 14

    Dostálová S, Šonka K, Šmahel Z, Weiss Vr & Marek J Cephalometric assessment of cranial abnormalities in patients with acromegaly. Journal of Cranio-Maxillofacial Surgery 2003 31 8087. (https://doi.org/10.1016/S1010-5182(0200182-8)

    • Search Google Scholar
    • Export Citation
  • 15

    Kosilek RP, Frohner R, Wurtz RP, Berr CM, Schopohl J, Reincke M & Schneider HJ Diagnostic use of facial image analysis software in endocrine and genetic disorders: review, current results and future perspectives. European Journal of Endocrinology 2015 173 M39M 44. (https://doi.org/10.1530/EJE-15-0429)

    • Search Google Scholar
    • Export Citation
  • 16

    Plooij JM, Swennen GR, Rangel FA, Maal TJ, Schutyser FA, Bronkhorst EM, Kuijpers-Jagtman AM & Berge SJ Evaluation of reproducibility and reliability of 3D soft tissue analysis using 3D stereophotogrammetry. International Journal of Oral and Maxillofacial Surgery 2009 38 267273. (https://doi.org/10.1016/j.ijom.2008.12.009)

    • Search Google Scholar
    • Export Citation
  • 17

    Chen W, Qian W, Wu G, Chen W, Xian B, Chen X, Cao Y, Green CD, Zhao F & Tang K et al. Three-dimensional human facial morphologies as robust aging markers. Cell Research 2015 25 574587. (https://doi.org/10.1038/cr.2015.36)

    • Search Google Scholar
    • Export Citation
  • 18

    Wagenmakers MAEM, Roerink SHPP, Maal TJJ, Pelleboer RH, Smit JWA, Hermus ARMM, Berge SJ, Netea-Maier RT & Xi T Three-dimensional facial analysis in acromegaly: a novel tool to quantify craniofacial characteristics after long-term remission. Pituitary 2015 18 126134. (https://doi.org/10.1007/s11102-014-0565-x)

    • Search Google Scholar
    • Export Citation
  • 19

    Hoevenaren IA, Wagenmakers MA, Roerink SH, Netea-Maier RT, Ulrich DJ & Maal TJ Three-dimensional soft tissue analysis of the hand: a novel method to investigate effects of acromegaly. European Journal of Plastic Surgery 2016 39 429434. (https://doi.org/10.1007/s00238-016-1217-3)

    • Search Google Scholar
    • Export Citation
  • 20

    Shin HJ, Song WC, Lee SH, Ha HJ & Koh KS Consistency of the lateral canthus as an anatomic landmark and its clinical implications. Clinical Anatomy 2019 32 630634. (https://doi.org/10.1002/ca.23360)

    • Search Google Scholar
    • Export Citation
  • 21

    Chin OY & Sykes JM Optimizing the chin and jawline appearance: does surgery or injection make sense? Facial Plastic Surgery 2019 35 164171. (https://doi.org/10.1055/s-0039-1683962)

    • Search Google Scholar
    • Export Citation
  • 22

    Nguyen J, Duong HAnatomy, Head and Neck, Face. 2020 Jul 27. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.

  • 23

    Fujio S, Arimura H, Hirano H, Habu M, Bohara M, Moinuddin FM, Kinoshita Y & Arita K Changes in quality of life in patients with acromegaly after surgical remission – a prospective study using SF-36 questionnaire. Endocrine Journal 2017 64 2738. (https://doi.org/10.1507/endocrj.EJ16-0182)

    • Search Google Scholar
    • Export Citation
  • 24

    Yoshida K, Fukuoka H, Matsumoto R, Bando H, Suda K, Nishizawa H, Iguchi G, Ogawa W, Webb SM & Takahashi Y The quality of life in acromegalic patients with biochemical remission by surgery alone is superior to that in those with pharmaceutical therapy without radiotherapy, using the newly developed Japanese version of the AcroQoL. Pituitary 2015 18 876883. (https://doi.org/10.1007/s11102-015-0665-2)

    • Search Google Scholar
    • Export Citation
  • 25

    Sardella C, Lombardi M, Rossi G, Cosci C, Brogioni S, Scattina I, Webb SM, Gasperi M, Martino E & Bogazzi F Short- and long-term changes of quality of life in patients with acromegaly: results from a prospective study. Journal of Endocrinological Investigation 2010 33 2025. (https://doi.org/10.1007/BF03346555)

    • Search Google Scholar
    • Export Citation
  • 26

    Han K, Park M, Choi T, Choi J, Kim J, Son D & Jeong W Septal integration graft, a modified direct type of septal extension graft for the treatment of unilateral cleft lip nose deformity: an anthropometric analysis. Annals of Plastic Surgery 2020 84 4752. (https://doi.org/10.1097/SAP.0000000000002118)

    • Search Google Scholar
    • Export Citation
  • 27

    Wang Y, Guo S, Sun Q, Jin SF, Zhang X, Xiao M, Wang CC, Sun X, Lv MZ & Li KZ Anthropometric labial analysis of Han Chinese young adults. Skin Research and Technology 2019 25 499503. (https://doi.org/10.1111/srt.12678)

    • Search Google Scholar
    • Export Citation
  • 28

    Colao A, Ferone D, Marzullo P & Lombardi G Systemic complications of acromegaly: epidemiology, pathogenesis, and management. Endocrine Reviews 2004 25 102152. (https://doi.org/10.1210/er.2002-0022)

    • Search Google Scholar
    • Export Citation
  • 29

    Xie T, Ding H, Xia M, Zhang X, Sun W, Liu T, Gu Y, Sun C & Hu F Dynamic changes in the distribution of facial and abdominal adipose tissue correlated with surgical treatment in acromegaly. Endocrine 2018 62 552559. (https://doi.org/10.1007/s12020-018-1742-x)

    • Search Google Scholar
    • Export Citation
  • 30

    Choi SH, Fan D, Hwang MS, Lee HK & Hwang CJ Effect of growth hormone treatment on craniofacial growth in children: idiopathic short stature versus growth hormone deficiency. Journal of the Formosan Medical Association 2017 116 313321. (https://doi.org/10.1016/j.jfma.2016.05.011)

    • Search Google Scholar
    • Export Citation
  • 31

    Danna NR, Beutel BG, Ramme AJ, Kirsch T, Kennedy OD & Strauss E The effect of growth hormone on chondral defect repair. Cartilage 2018 9 6370. (https://doi.org/10.1177/1947603516678973)

    • Search Google Scholar
    • Export Citation
  • 32

    Maffezzoni F & Formenti AM Acromegaly and bone. Minerva Endocrinology 2018 43 168182. (https://doi.org/10.23736/S0391-1977.17.02733-X)