Effects of Therapies in the Acromegaly Disease: Acral Morpho-functional Study

Effects of Therapies in the Acromegaly Disease: Acral Morpho-functional Study

Acromegaly is a rare chronic disease due to excessive secretion of growth hormone (GH) and insulin-like growth factor-I (IGF-I), caused in over 98% of cases by GH-secreting pituitary adenoma. Prolonged exposure to GH/IGF-I excess is the cause of increased mortality and morbidity in these patients. Arthropathy occurs in about 75% of acromegalic patients. Any joint may be affected, with the development of osteoarthritis, arthralgia, and an increase in fracture risk.

The aims of the present project are to evaluate the dimensions of hands and feet with the 3D scanner method and to perform a quantitative analysis of movement through Gait Analysis technique in de novo patients with acromegaly (group # 1) and in patients with different disease status (group #2).

This is an observational, prospective study that aims to evaluate the effect of acromegalic disease and medical/surgical therapy on acral morpho-functional alterations.

To outline the morphological characteristics of the extremities (hands and feet), a three-dimensional laser scanning system will be used able to measure the geometrical and volumetric characteristics of the hands and feet of these subjects. The three-dimensional scanning system that will be used is the portable FastScan system (marketed by Rodin), previously used for the volumetric evaluation of the lower and upper limbs of subjects suffering from lymphedema and lipedema. The processing of the image and the parameters will be carried out through two softwares: Rodin4DScan, which carries out the reconstruction of the shape after the scan, and Rodin4D, which allows the construction of the final shape and allows the processing of the various parameters to the morphology of the extremity.

The following tests will be used to characterize posture and balance control during walking:

• maintenance of the bipedal indifferent orthostatic posture, with open and closed eyes;
• walking on level ground, barefoot, at natural speed (10 m walking test)

The instrumentation (BTS GAITLAB) that will be used consists of:

• 8-camera stereophotogrammetric system (SMART DX, BTS-Bioengineering, IT);
• two dynamometric platforms (AMTI, USA);
• a baropodometric platform (P-WALK; BTS-Bioengineering, IT).

The variables analyzed will be divided according to the administered tests:

1. maintenance of the orthostatic posture: anteroposterior and mediolateral excursion of the center of pressure, speed of displacement of the center of pressure, length of postural ball and distribution of plantar pressures;
2. gait: spatio-temporal parameters, kinematics of trunk and joints of lower limbs, ground reaction forces, moments and joint powers.

A functional evaluation of the foot will be also performed positioning the patient prone/supine on the bed and measuring several joint angles.

The measurement will be supported by a video from which images can be subsequently processed to trace and obtain the joint angles.

For the functional evaluation of the hand, the patient will be evaluated with the following outcome measures:

1. Algo-functional index of the hand according to Dreiser, which analyzes the ability to execute some gestures of daily life;
2. Duruöz index, questionnaire for assessing functional impairment of hand.

Inclusion Criteria:

• De novo patients with acromegaly (group # 1), diagnosed according to Endocrine Society guidelines,
• Age equal to18 years or older
• Acromegalic patients with different disease status (group #2)
• Age equal to18 years or older

Exclusion Criteria:

• Cardiorespiratory, neurological or musculoskeletal disorder
• Previous orthopaedic surgery
• Previous lower limbs traumatic injuries