Arthropathy in Acromegaly

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Definition

Acromegaly is a chronic and slowly developing endocrinopathy caused by hypersecretion of growth hormone (GH) and consequently of insulinlike growth factor 1 (IGF-1) due to GH-secreting pituitary tumor. Other causes, such as increased growth hormone–releasing hormone production from hypothalamic tumors, ectopic growth hormone–releasing hormone production, and ectopic GH secretion from nonendocrine tumors, are rare.

Epidemiology and pathogenesis

Acromegaly most commonly occurs in middle-aged men and women. Its prevalence is approximately 4.6 cases per million population, and the incidence is 116.9 new cases per million per year.1

Hypersecretion of GH affects all organs, causing disturbances in morphology, endocrine function, and metabolism. GH released into circulation stimulates production of IGF-1, which is the primary mediator of the growth-promoting effects of GH. GH stimulates growth of soft tissue and fibroblast proliferation too,

Clinical features of acromegaly

The most typical features of acromegaly are listed in Box 1.3

Prognosis

Prognosis of acromegaly is dependent on early detection and treatment of the disease. Acromegalic patients demonstrate a 2- to 4-fold increase in mortality relative to the general population.

Musculoskeletal manifestations

Musculoskeletal pain is a frequent problem encountered in acromegaly and is associated with a reduction in quality of life. Joint symptoms are the most frequent complaint, affecting approximately 70% of individuals at the time of diagnosis. Among musculoskeletal symptoms, the most prevalent are arthropathy, carpal tunnel syndrome, proximal myopathy, and fibromyalgia. A less discussed but frequent sign is bone mass alteration leading to osteoporosis.

Treatment of acromegaly

Surgery is indicated when there is a large tumor with impingement of the optic chiasm or nerve and in all other cases of a high presurgical likelihood of complete resection of the adenoma and, therefore, possible cure. Important predictors of possible surgical cure are location, invasiveness of the tumor, and the preoperative GH levels.

For all other patients, long-acting somatostatin analog treatment should be used. Somatostatin analog is frequently considered as first-line therapy in

Summary

Articular involvement in acromegaly is one of the most frequent clinical complications and may be present as the earliest symptom in a significant proportion of patients. The involvement of other organs may be of clinical importance and contribute to increased morbidity and mortality of patients suffered from acromegaly. Early diagnosis and proper treatment of the diseases can prevent the development of irreversible complications of the disease and improve the quality of life in patients

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