Arthropathy in Acromegaly

Killinger, Zdenko; Payer, Juraj; Lazúrová, Ivica; Imrich, Richard; Homerova, Zuzana; Kužma, Martin; Rovenský, Jozef

doi:10.1016/j.rdc.2010.09.004

Cited by 46 publications

(33 citation statements)

References 12 publications

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“…Among the 16,821 patients who responded negatively to two items of the questionnaire, 1,806 subjects with recently diagnosed (< 5 years) arterial hypertension requiring antihypertensive medication, associated with at least one other comorbidity of acromegaly, were subsequently selected for this study. These comorbidities were (18,19): (i) nonspecific chronic headache (for example, migraine and hypertensive headache were not considered); (ii) generalized and persistent excessive sweating; (iii) diffuse arthralgias associated with some radiologic alteration (20) in the absence of known rheumatological disease (reported by the patient, suspected, or confirmed in the medical record); (iv) chronic fatigue not explained by any other underlying disease (among the diagnoses reported by the patient or present in the medical record); (v) bilateral paresthesias (Carpal tunnel syndrome); (vi) recently diagnosed diabetes mellitus.…”

Section: Methodsmentioning

confidence: 99%

Screening for acromegaly in adult patients not reporting enlargement of the extremities, but with arterial hypertension associated with another comorbidity of the disease

Rosário

Calsolari

2014

Arq Bras Endocrinol Metab

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Objective To determine the value of acromegaly screening in adult patients not reporting enlargement of the extremities, but who present arterial hypertension associated with at least one other comorbidity of the disease. Subjects and methods Patients seen by general practitioners at primary health care units were evaluated. Among the patients without extremity enlargement, those with recently diagnosed arterial hypertension associated with at least one other comorbidity were selected. Results A total of 1,209 patients were submitted to laboratory investigation. Elevated IGF‐1 was observed in 22 patients. Eighteen patients had adequate suppression of growth hormone (GH). No GH suppression was observed in four women with confirmed elevated IGF‐1. In the latter, IGF‐1 and nadir GH were only slightly elevated, magnetic resonance showed a normal pituitary, and chest and abdominal computed tomography revealed no tumor, and no intervention was performed. Conclusion In patients with arterial hypertension without known pituitary disease, acromegaly is unlikely in the absence of enlargement of the extremities.

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Section: Methodsmentioning

confidence: 99%

Screening for acromegaly in adult patients not reporting enlargement of the extremities, but with arterial hypertension associated with another comorbidity of the disease

Rosário

Calsolari

2014

Arq Bras Endocrinol Metab

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“…The pathogenesis of arthropathy in acromegaly may involve two mechanisms: initial endocrine and subsequent mechanical changes (12,13). At the initial stage, GH and IGF-1 lead to hyperfunction of articular chondrocytes and increased matrix synthesis, resulting in growth of periarticular structures.…”

Section: Discussionmentioning

confidence: 99%

“…Arthropathy can affect both axial and peripheral joints; the most involved are hips, shoulders, knees, hands, and elbows. It is frequently irreversible despite treatment, and may contribute to decreased quality of life (Qol) (12). Musculoskeletal impairment is related to articular damage and its prevalence and severity worsens with the duration of uncontrolled disease, resulting in significant physical disability (13).…”

Section: Introductionmentioning

confidence: 99%

Avaliação da atividade física na prática de vida diária comparada com o nível de atividade da doença em pacientes acromegálicos: impacto na percepção da qualidade de vida

Dantas

Passos

Porto

et al. 2013

Arq Bras Endocrinol Metab

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Objective:To evaluate the quality of life and its association with daily physical activity and disease control in acromegalic patients. Subjects and methods: A cross-sectional, case series study, composed of 42 patients recruited from the Neuroendocrinology Unit of the University Hospital of Brasilia. Level of physical activity was accessed by the International Physical Activity Questionnaire (IPAQ 6-short-form), which evaluates the weekly time spent on physical activity of moderate to vigorous intensity in different contexts of life. Quality of life was evaluated by The Medical Outcome Study Questionnaire Short Form (SF-36). Data was compared to growth hormone (GH) and insulin-like growth factor (IGF-1) levels. Students' t test and Fisher test were used, p < 0.05, SPSS 17.0. Results: Twenty--two women, aged 51.33 ± 14.33 and 20 men, aged 46.2 ± 13.18 were evaluated. Arthralgia was present in 83% of cases. In men, the most common sites of pain were the knees (73%), spine (47% lumbar, and 53% thoracic and cervical segments), hands and wrists (40%). Higher scores on SF-36 were observed in patients with intermediate or high levels of physical activity, in the domains social functioning (75 CI 57.3-92.6), general health (75.5 CI 60.4-90.5), mental health (70 CI 57.8-82.1). Conclusions: In this study, the presence and severity of physical disability and pain were not associated with initial GH and IGF-1 levels or time of exposure to GH excess. However, the patients considered controlled, with normal a normal age-adjusted IGF-1, presented higher scores in SF-36, in physical and emotional domains, compared with patients with persistent hypersomatotrophism. These findings suggest benefits of metabolic control in self-reported quality of life. Arq Bras Endocrinol Metab. 2013;57(7):550-7 Keywords Acromegaly; quality of life; functional capacity; activities in daily life RESUMO Objetivo: Avaliar a qualidade de vida e sua associação com a prática de vida diária e controle metabóli-co em pacientes portadores de acromegalia. Sujeitos e métodos: Estudo seccional de série de casos, composto por 42 pacientes recrutados na Unidade de Neuroendocrinologia do Hospital Universitário de Brasília. O nível de atividade física foi estimado pelo Questionário Internacional de Atividade Física (IPAQ-6), que avalia o tempo gasto semanalmente em atividades físicas que variam de intensidade em diferentes contextos de vida. A qualidade de vida foi avaliada pelo questionário SF-36. Os dados obtidos foram comparados aos níveis de hormônio do crescimento (GH) e fator de crescimento semelhante à insulina (IGF-1). Os testes t Students e Fisher foram aplicados e p < 0,05 foram considerados significativos, SPSS 17.0. Resultados: Avaliaram-se 22 mulheres com idades de 51,33 ± 14,33 e 20 homens com idades de 46,2 ±13,18. Artralgia foi relatada em 83% dos pacientes. Em homens, os sítios de dor mais comuns foram os joelhos (73%), coluna vertebral (47% lombar, 53% segmentos torácico e cervical), mãos e quadris (40%). Os maiores escores no SF-36 fo...

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“…The comorbidities considered were (1,3,5): i) nonspecific chronic headache (for example, migraine and hypertensive headache were not considered); ii) generalized and persistent excessive sweating; iii) diffuse arthralgias associated with some radiologic alteration (22) in the absence of known rheumatological disease (reported by the patient, suspected, or confirmed in the medical record); iv) chronic fatigue not explained by any other underlying disease (among the diagnoses reported by the patient or present in the medical record); v) bilateral paresthesias (Carpal tunnel syndrome); vi) recently diagnosed diabetes mellitus; vii) recently diagnosed arterial hypertension requiring antihypertensive medication.…”

Section: Definitionsmentioning

confidence: 99%

Long-term follow-up of patients with elevated IGF-1 and nadir GH > 0.4 µg/L but < 1 µg/L

Rosário

Calsolari

2017

Arch. Endocrinol. Metab.

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Objective: To report the results of initial investigation and after 5 years of patients with a suspicious clinical scenario for acromegaly, elevated IGF-1, and nadir GH during an oral glucose tolerance test (OGTT) > 0.4 µg/L but < 1 µg/L. Subjects and methods: Seventeen patients who had elevated IGF-1 (outside puberty and pregnancy) in two measurements and GH between 0.4 and 1 µg/L during OGTT were selected. Results: During initial assessment, only one patient had microadenoma on magnetic resonance imaging (MRI) of the pituitary. In this patient, IGF-1 returned to normal spontaneously after 5 years. In the remaining 16 patients, spontaneous normalization of IGF-1 was observed in four and IGF-1 continued to be elevated in 12 after 5 years. None of the latter patients developed a phenotype of acromegaly, changes in physiognomy or increase in IGF-1 and no tumor was detected by imaging methods. Two patients had nadir GH < 0.4 µg/L, while the nadir GH remained between 0.4 and 1 µg/L in 10 patients. Conclusion: In patients (notably young adult or adult women) without a typical phenotype in whom IGF-1 is measured due to a suspicious clinical scenario and is found to be slightly elevated, even if confirmed and in the absence of other causes, a nadir GH cut-off value of 0.4 µg/L instead of 1 µg/L in the OGTT might be inadequate for the diagnosis. Arch Endocrinol Metab. 2017;61(5):426-31

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Arthropathy in Acromegaly

Cited by 46 publications

References 12 publications

Screening for acromegaly in adult patients not reporting enlargement of the extremities, but with arterial hypertension associated with another comorbidity of the disease

Screening for acromegaly in adult patients not reporting enlargement of the extremities, but with arterial hypertension associated with another comorbidity of the disease

Avaliação da atividade física na prática de vida diária comparada com o nível de atividade da doença em pacientes acromegálicos: impacto na percepção da qualidade de vida

Long-term follow-up of patients with elevated IGF-1 and nadir GH > 0.4 µg/L but < 1 µg/L

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