between the anxiety and depression scores, as assessed with
the HADS, and all other scores is not straightforward. It
could be that the HADS is a very sensitive measure of quality
of life. Alternatively, and perhaps more likely, increased
feelings of anxiety and depression may modulate the experience
of all other complaints (26).
In this cross-sectional study we were not able to identify
the treatment modality that resulted in the best quality of life.
In this respect, only patients with long-term cure by a single
surgical procedure without (partial) hypopituitarism were
comparable to controls for some items. Irradiated subjects
performed worse on general fatigue, reduced motivation,
energy, physical mobility, and physical function. Others also
have suggested a decreased quality of life in mental health
(SF-36) and due to depression and decreased control of emotions
(General Well-Being Schedule) in patients after pituitary
irradiation (25).
The somatotropic system interacts with cognition, mood,
and well-being. However, the mechanism by which GH and
IGF-I act is not well understood. In depressive states, reduced
GH secretion or impaired GH release after stimuli is
observed (27). After institution of rhGH replacement in GHdeficient
patients, the decreased quality of life and mood
scores improve in most reports. Therefore, a direct effect on
the central nervous system, leading to mood disorders and
decreased quality of life, may be present in GH disorders,
although not assessed in GH excess states. Whether these
effects are reversible has not been assessed in longitudinal
studies. The decreased scores in the present cross-sectional
study may be explained theoretically by irreversible GH/
IGF-I induced changes in the central nervous system, may be
caused by limitations due to persisting invalidating symptoms,
or could be due to the psychological effects of living
with a disease and its treatment. Also, long-term withdrawal
effects may have led to irreversible alterations in perceived
quality of life (28, 29).
In summary, quality of life in long-term cured acromegalic
patients is reduced compared with that in controls, as
assessed by four health-related and one disease-specific
questionnaires. Pituitary radiotherapy affects quality of life,
especially on the fatigue and physical performance scales