Abstract
The purpose of this article is to summarise the early musculoskeletal complications of acromegaly. Some of the early signs of acromegaly may be evaluated by the musculoskeletal radiologist. In the early stage of disease, peripheral nerve enlargement associated with carpal tunnel syndrome or cubital tunnel syndrome and thickening of retinacula, such as A1 pulley in trigger finger, represent the features that may be seen by radiologists and are worthy of an endocrinological evaluation. Due to the insidious nature of the disease, the diagnosis of acromegaly is significantly delayed. Few and nonspecific symptoms characterise the initial phases of the disease, and therefore, most patients will have generally consulted many specialists (most frequently musculoskeletal radiologists) before an adequate endocrinological assessment is performed. For this reason, initial clinical signs are much more important than symptoms for an early diagnosis of acromegaly. The first and most important therapeutic approach to acromegaly is early diagnosis, whereas the therapeutic goals are to eliminate morbidity and reduce mortality to the expected age- and sex-adjusted rates and prevent the development of systemic complications. Musculoskeletal radiologists should be aware that these features may be early manifestations of acromegaly. When both radiological and clinical abnormalities are present, an endocrinological workup is useful to diagnose the disease in an early phase.
Riassunto
L’obiettivo del lavoro è di riassumere le complicanze precoci dell’acromegalia. Tra i segni precoci dell’acromegalia alcuni possono essere riconosciuti dal radiologo muscolo-scheletrico. Nelle fasi precoci della malattia l’ingrandimento dei nervi periferici associato alla sindrome del tunnel carpale o del tunnel cubitale e l’ispessimento dei retinacoli come la puleggia A1 nel dito a scatto rappresentano i segni che possono essere notati dal radiologo e che meriterebbero una valutazione specialistica endocrinologica. La diagnosi di acromegalia è tipicamente ritardata dalla natura insidiosa della malattia. Nelle fasi iniziali i sintomi possono essere pochi e aspecifici, pertanto i pazienti consultano molti specialisti, tra cui il radiologo muscolo-scheletrico, prima di effettuare una visita specialistica endocrinologica. Per questo motivo, per una diagnosi precoce, i segni clinici iniziali sono importanti più dei sintomi clinici aspecifici. Dato che gli obiettivi terapeutici sono la riduzione della morbilità e della mortalità, la diagnosi precoce rimane il miglior approccio terapeutico possibile per prevenire le complicanze sistemiche.
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Tagliafico, A., Resmini, E., Ferone, D. et al. Musculoskeletal complications of acromegaly: what radiologists should know about early manifestations. Radiol med 116, 781–792 (2011). https://doi.org/10.1007/s11547-011-0671-z
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DOI: https://doi.org/10.1007/s11547-011-0671-z