Bone and Joint Disorders in Acromegaly

Claessen, Kim M J A; Mazziotti, Gherardo; Biermasz, Nienke R.; Giustina, Andrea

doi:10.1159/000375450

Cited by 71 publications

(40 citation statements)

References 94 publications

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“…2). Arthropathy is one of the most prevalent and invalidating complications of acromegaly, affecting both weight-and non-weightbearing joints (132).…”

Section: Diagnosis Of Osteopathy In Acromegalymentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Bone disorders associated with acromegaly: mechanisms and treatment

Mazziotti

Lania

Canalis

2019

European Journal of Endocrinology

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Growth hormone (GH) and insulin-like growth factor-I (IGF-I) exert physiological actions on the skeleton throughout life, by stimulating longitudinal bone growth in children, the acquisition of bone mass during adolescence and the maintenance of skeletal architecture in adults. When GH and IGF-I are secreted in excess, bone remodeling is enhanced leading to deterioration of bone microstructure and impairment of bone strength. Indeed, acromegaly causes skeletal fragility, and vertebral fractures are reported in a remarkable number of subjects exposed to GH and IGF-I excess. The management of skeletal fragility in acromegaly is a challenge, since the awareness of this complication is low, the prediction of fracture risk is difficult to ascertain, the risk of fractures remains after the control of acromegaly and the effectiveness of bone-active drugs is unknown. This review is an update on bone disorders associated with acromegaly and provides a perspective of possible therapeutic approaches based on emerging pathophysiological and clinical information.

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“…2). Arthropathy is one of the most prevalent and invalidating complications of acromegaly, affecting both weight-and non-weightbearing joints (132).…”

Section: Diagnosis Of Osteopathy In Acromegalymentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Bone disorders associated with acromegaly: mechanisms and treatment

Mazziotti

Lania

Canalis

2019

European Journal of Endocrinology

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“…Skin manifestations, such as perspiration, soft tissue swelling or numbness, caused by an increase in extracellular volume, edema, dermal glycosaminoglycan accumulation or increased vasoconstriction, are usually rapidly alleviated when GH and IGF-I levels are controlled [52, 62]. Conversely, joint pain may rather reflect chronic and irreversible changes [63, 64], so that biochemical control per se may not be sufficient to alleviate them, whereas headache may better respond to centrally active drugs like SRL [65]. For these reasons, additional pain treatment may be needed to relieve these symptoms.…”

Section: Global Clinical Effectsmentioning

confidence: 99%

Pegvisomant in acromegaly: an update

Giustina

Arnaldi

Bogazzi

et al. 2017

J Endocrinol Invest

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BackgroundIn 2007, we published an opinion document to review the role of pegvisomant (PEG) in the treatment of acromegaly. Since then, new evidence emerged on the biochemical and clinical effects of PEG and on its long-term efficacy and safety.AimWe here reviewed the emerging aspects of the use of PEG in clinical practice in the light of the most recent literature.ResultsThe clinical use of PEG is still suboptimal, considering that it remains the most powerful tool to control IGF-I in acromegaly allowing to obtain, with a pharmacological treatment, the most important clinical effects in terms of signs and symptoms, quality of life and comorbidities. The number of patients with acromegaly exposed to PEG worldwide has become quite elevated and the prolonged follow-up allows now to deal quite satisfactorily with many clinical issues including major safety issues, such as the concerns about possible tumour (re)growth under PEG. The positive or neutral impact of PEG on glucose metabolism has been highlighted, and the clinical experience, although limited, with sleep apnoea and pregnancy has been reviewed. Finally, the current concept of somatostatin receptor ligands (SRL) resistance has been addressed, in order to better define the acromegaly patients to whom the PEG option may be offered.ConclusionsPEG increasingly appears to be an effective and safe medical option for many patients not controlled by SRL but its use still needs to be optimized.

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“…Growth hormone (GH) and insulin-like growth factor-1 (IGF1) are important regulators of bone remodeling in children and adults (1,2). In vitro GH stimulates the proliferation, differentiation and function of osteoblasts (1).…”

Section: Introductionmentioning

confidence: 99%