Postural balance and peripheral muscle function in elderly patients with acromegaly

Abstract

Introduction: Acromegaly is a rare endocrine disorder characterized by elevated hormone levels of growth hormone (GH) and insulin-like growth factor I (IGF-I), which contributes to its systemic evolution with overgrowth of the soft tissue and functionally weaker muscles. Advances in the treatment for acromegaly in recent decades are gradually leading to an increase in the survival rate of these patients. Thus, there has been a growing concern about the appropriate physical therapy monitoring as the acromegaly age. Objectives: To evaluate static and dynamic postural balance in elderly patients with acromegaly and compare them with healthy elderly. The specific objectives are: (1) to evaluate the static and dynamic balance of acromegaly elderly through the Berg scale, Dynamic Gait Index test (DGI), Timed up and GO test (TUG), and Tinetti scale; (2) to evaluate the integrity and level of physical activity of acromegaly elderly through Lower Extremity Functional Scale (LEFS) questionnaire, Falls Efficacy Scale (FES-I), and International Physical Activity Questionnaire (IPAQ); (3) to evaluate the peripheral muscle function of acromegaly elderly through the handgrip and isokinetic knee strength; and (4) to compare the postural balance, handgrip and isokinetic knee strength of the elderly acromegalics with the control group. Methods: Seventeen elderly acromegalics and twenty controls matched for sex, age, weight, height and body mass index were subjected to test of static balance using force platform in two different positions: feet apart, eyes open and feet together, eyes closed, beyond the dynamic balance and assessment of peripheral muscle function through the handgrip and knee isokinetic dynamometer. Results: Compared to healthy controls, elderly acromegalics had lower values for almost all parameters with significant differences in peak torque in extension at 240º/s (P = 0.028), maximum repetition of the total work in extension at 240º/s (P = 0.034), and total work in extension at 240º/s (P = 0.013). On the force platform, they showed higher values in the posture feet together, eyes closed compared to posture feet apart, eyes open. The group of elderly acromegalics showed higher stabilometric values in the parameters medial-lateral range with feet apart, eyes open (P = 0.017), and medial-lateral range with feet together, eyes closed (P = 0.028). There were significant differences between patients and controls in various balance scales and gait. Conclusion: Elderly acromegalics have lateral instability, which impairs the body balance and increase the risk of falls. There is a propensity for muscle fatigue in these patients. These data underline the importance of these assessments in clinical practice.