Skip to main content

Advertisement

SpringerLink
Log in

Is every joint symptom related to acromegaly?

  • Original Article
  • Published:
Endocrine Aims and scope Submit manuscript

Abstract

Acromegaly is a chronic endocrinopathy characterized by the hypersecretion of growth hormone and insulin-like growth factor-1. Musculoskeletal pain is a frequent problem encountered in acromegaly and is associated with a reduction in the quality of life. In this study, the presence of inflammatory and degenerative rheumatologic diseases in acromegaly has been retrospectively evaluated. Forty patients with acromegaly who were in remission according to laboratory findings, but still having joint and back pain problems, were referred to rheumatology outpatient clinic and all the patients were examined by clinical, radiological, and laboratory data. Mean age was 47.1 years (22–75). When the radiological data were evaluated, erosions of the left sacroiliac joint were found by means of magnetic resonance imaging in 1 patient and degenerative joint changes were observed in 24 patients by X-ray imaging. However, there was no pathology in the radiological data of 15 patients. Laboratory data revealed antinuclear antibody positivity (3 nucleolar and 1 homogeneous) in 4 patients, rheumatoid factor positivity in 4, and cyclic citrullinated peptide positivity only in 1 patient. The diagnosis of an inflammatory rheumatologic disease, including rheumatoid arthritis, ankylosing spondylitis, or undifferentiated connective tissue disease was made in 3 patients. Besides, the diagnosis of diffuse idiopathic skeletal hyperostosis was also established in 6 patients. While degenerative joint diseases were frequently observed in our group similar to the literature, inflammatory rheumatologic diseases were also found in three patients. Distinguishing these two diseases is important because response to medical treatment is dramatically better in inflammatory diseases than in degenerative pathologies. A multidisciplinary approach is imperative for appropriate management of these patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. S. Melmed, Acromegaly. N. Engl. J. Med. 5, 966–977 (1990)

    Article  Google Scholar 

  2. A. Ben Shlomo, S. Melmed, Acromegaly. Endocrinol. Metab. Clin. N. Am. 30, 565–583 (2001)

    Google Scholar 

  3. Z. Killinger, J. Payer, I. Lazúrová, R. Imrich, Z. Homérová, M. Kužma, J. Rovenský, Arthropathy in acromegaly. Rheum. Dis. Clin. N. Am. 36, 713–720 (2010)

    Article  CAS  Google Scholar 

  4. R. Scarpa, D. De Brasi, R. Pivonello, P. Marzullo, F. Manguso, A. Sodano, P. Oriente, G. Lombardi, A. Colao, Acromegalic axial arthropathy: a clinical case-control study. J. Clin. Endocrinol. Metab. 89, 598–603 (2004)

    Article  PubMed  CAS  Google Scholar 

  5. L.C. Detenbeck, H.A. Tressler, J.D. O’Duffy, R.V. Randall, Peripheral joint manifestations of acromegaly. Clin Ortop Relat Res. 91, 119–127 (1973)

    Google Scholar 

  6. M. Rudwaleit, R. Landewé, D. van der Heijde, J. Listing, J. Brandt, J. Braun, R. Burgos-Vargas, E. Collantes-Estevez, J. Davis, B. Dijkmans, M. Dougados, P. Emery, I.E. van der Horst-Bruinsma, R. Inman, M.A. Khan, M. Leirisalo-Repo, S. van der Linden, W.P. Maksymowych, H. Mielants, I. Olivieri, R. Sturrock, K. de Vlam, J. Sieper, The development of Assessment of Spondyloarthritis International Society classification criteria for axial spondyloarthritis (part I): classification of paper patients by expert opinion including uncertainty appraisal. Ann. Rheum. Dis. 68, 770–776 (2009)

    Article  PubMed  CAS  Google Scholar 

  7. E. Villeneuve, J. Nam, P. Emery, ACR-EULAR classification criteria for rheumatoid arthritis. Rev. Bras. Reumatol. 50(5), 481–483 (2010)

    PubMed  Google Scholar 

  8. P.D. Utsinger, Diffuse İdiopathic skeletal hyperostosis. Clin. Rheum. Dis. 11, 325 (1985)

    PubMed  CAS  Google Scholar 

  9. N.R. Biermasz, A.M. Pereira, J.W. Smit, J.A. Romijn, F. Roelfsema, Morbidity after long-term remission for acromegaly: persisting joint-related complaints cause reduced quality of life. J. Clin. Endocrinol. Metab. 90, 731–739 (2005)

    Article  Google Scholar 

  10. J.J. Chipman, A.F. Attanasio, M.A. Birkett, P.C. Bates, S. Webb, S.W. Lamberts, The safety profile of GH replacement therapy in adults. Clin. Endocrinol. 46, 473–481 (1997)

    Article  CAS  Google Scholar 

  11. M.J. Wassenaar, N.R. Biermasz, N. Van Diunen, A.A. Van Der Klaauw, A.M. Pereira, F. Roelfsema, J.W. Smit, H.M. Kroon, M. Kloppenburg, J.A. Romijn, High prevalence of arthropathy, according to the definitions of radiological and clinical osteoarthritis, in patients with long-term cure of acromegaly: a case-control study. Eur. J. Endocrinol. 160(3), 357–365 (2009)

    Article  PubMed  CAS  Google Scholar 

  12. A. Colao, P. Marzullo, G. Vallone, V. Marinò, M. Annecchino, D. Ferone, D. De Brasi, R. Scarpa, P. Oriente, G. Lombardi, Reversibility of joint thickening in acromegalic patients: an ultrasonography study. J. Clin. Endocrinol. Metab. 83(6), 2121–2125 (1998)

    Article  PubMed  CAS  Google Scholar 

  13. A. Colao, R. Pivonello, R. Scarpa, G. Valloe, C. Ruosi, G. Lombardi, The acromegalic arthropathy. J. Endocrinol. Invest. 28(suppl), 24–31 (2005)

    PubMed  CAS  Google Scholar 

  14. Y. Aydın, H. Coşkun, S. Yazici, O. Kudaş, A. Güngör, Rheumatoid arthritis masquerading as acromegaly recurrence: report of two cases. Rheumatol. Int. 1490–1496 (2010)

  15. L. Ozcakar, A. Akinci, S. Bal, A challenging case of rheumatoid arthritis in an acromegalic patient. Rheumatol. Int. 23, 146–148 (2003)

    PubMed  Google Scholar 

  16. R.C. Read, I. Watt, P.A. Dıeppe, Rheumatoid arthritis and acromegaly—effect of growth factors on RA? Br. J. Rheumatol. 27(3), 242–243 (1988)

    Article  PubMed  CAS  Google Scholar 

  17. T. Miyoshi, F. Otsuka, T. Kawabata, K. Inagaki, T. Mukai, M. Kawashima, T. Ogura, M. Yamamura, T. Sei, H. Makino, Manifestation of rheumatoid arthritis after transsphenoidal surgery in a patient with acromegaly. Endocr. J. 53(5), 621–625 (2006)

    Article  PubMed  CAS  Google Scholar 

  18. M. Podgorski, B. Robinson, A. Weissberger, J. Stiel, S. Wang, P.M. Brooks, Articular manifestations of acromegaly. Aust. N. Z. J. Med. 18(1), 28–35 (1988)

    Article  PubMed  CAS  Google Scholar 

  19. R. Bluestone, E.G. Bywaters, M. Hartog, P.J. Holt, S. Hyde, Acromegalic arthropathy. Ann. Rheum. Dis. 30, 243 (1971)

    Article  PubMed  CAS  Google Scholar 

  20. L.B. Nachtigall, Acromegaly diagnosed in a young woman presenting with headache and arthritis. Nat. Clin. Pract. Endocrinol. Metab. 2(10), 582–587 (2006)

    Article  PubMed  Google Scholar 

  21. S. Lacks, R.P. Jacobs, Acromegalic arthropathy: a reversible rheumatic disease. J. Rheumatol. 13(3), 634–636 (1986)

    PubMed  CAS  Google Scholar 

  22. A. Colao, D. Ferone, P. Marzullo, G. Lombardi, Systemic complications of acromegaly: epidemiology, pathogenesis, and management. Endocr. Rev. 25, 102–152 (2004)

    Article  PubMed  CAS  Google Scholar 

  23. A. Giustina, G. Mazziotti, E. Canalis, Growth hormone, insulin-like growth factors, and the skeleton. Endocr. Rev. 29(5), 535–559 (2008)

    Article  PubMed  CAS  Google Scholar 

  24. S. Bonadonna, G. Mazziotti, M. Nuzzo, A. Bianchi, A. Fusco, L. De Marinis, A. Giustina, Increased prevalence of radiological spinal deformities in active acromegaly: a cross-sectional study in postmenopausal women. J. Bone Miner. Res. 20(10), 1837–1844 (2005)

    Article  PubMed  Google Scholar 

  25. G. Mazziotti, A. Bianchi, S. Bonadonna, V. Cimino, I. Patelli, A. Fusco, A. Pontecorvi, L. De Marinis, A. Giustina, Prevalence of vertebral fractures in men with acromegaly. J. Clin. Endocrinol. Metab. 93(12), 4649–4655 (2008)

    Article  PubMed  CAS  Google Scholar 

  26. G. Padova, G. Borzì, L. Incorvaia, G. Siciliano, V. Migliorino, M. Vetri, P. Tita, Prevalence of osteoporosis and vertebral fractures in acromegalic patients. Clin. Cases Miner. Bone Metab. 8(3), 37–43 (2011)

    PubMed  Google Scholar 

  27. G. Mazziotti, M. Gola, A. Bianchi, T. Porcelli, A. Giampietro, V. Cimino, M. Doga, C. Gazzaruso, L. De Marinis, A. Giustina, Influence of diabetes mellitus on vertebral fractures in men with acromegaly. Endocrine 40(1), 102–108 (2011)

    Article  PubMed  CAS  Google Scholar 

  28. M.J. Wassenaar, N.R. Biermasz, N.A. Hamdy, M.C. Zillikens, J.B. van Meurs, F. Rivadeneira, A. Hofman, A.G. Uitterlinden, M.P. Stokkel, F. Roelfsema, M. Kloppenburg, H.M. Kroon, J.A. Romijn, A.M. Pereira, High prevalence of vertebral fractures despite normal bone mineral density in patients with long-term controlled acromegaly. Eur. J. Endocrinol. 164(4), 475–483 (2011)

    Article  PubMed  CAS  Google Scholar 

  29. H.K. Genant, C.Y. Wu, C. van Kuijk, M.C. Nevitt, Vertebral fracture assessment using a semiquantitative technique. J. Bone Miner. Res. 8(9), 1137–1148 (1993)

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Endocrinology, Department of Internal Medicine, Izmir Atatürk Research and Training Hospital, Izmir, Turkey

    Gonca Örük

  2. Division of Rheumatology, Department of Internal Medicine, Izmir Atatürk Research and Training Hospital, Izmir, Turkey

    Figen Tarhan & Mustafa Özmen

  3. Department of Radiology, Ege University Medical Faculty, Bornova, Izmir, Turkey

    Mehmet Argın

Authors
  1. Gonca Örük
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Figen Tarhan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mehmet Argın
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mustafa Özmen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Figen Tarhan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Örük, G., Tarhan, F., Argın, M. et al. Is every joint symptom related to acromegaly?. Endocrine 43, 404–411 (2013). https://doi.org/10.1007/s12020-012-9770-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12020-012-9770-4

Keywords

Search

Navigation