Clinical Imaging Features of Thyroid Acropachy

Taguchi, Takafumi

doi:10.2169/internalmedicine.8188-21

Cited by 1 publication

(2 citation statements)

References 16 publications

(19 reference statements)

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“…For the above-mentioned signs and symptoms, possible differentials would be acromegaly, psoriatic arthritis, thyroid acropachy, etc 4 , 16 , 17 . Acromegaly, contrary to PDP presents with larger bones in the skull, face and limbs, jaw prognathism and associated increase in insulin-like-growth factor-1 levels and positive oral glucose tolerance test 4 .…”

Section: Discussionmentioning

confidence: 99%

“…Psoriatic arthritis such as psoriatic onycho-pachydermo-periostitis being limited to extremities with psoriatic nail changes and skin lesions, can also be excluded 16 . Thyroid acropachy manifests as periostosis and arthralgia with progressive exophthalmos, relatively symmetric swelling of the hands and feet, clubbing of the digits and pretibial myxoedema closely resembling PDP 17 . Clinical history and examination along with lab investigations suggested normal thyroid function in our case.…”

Section: Discussionmentioning

confidence: 99%

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Pachydermoperiostosis: a case report of initial improvement with etoricoxib

Vaidya,

Acharya,

Katila

et al. 2023

Annals of Medicine &Amp; Surgery

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Introduction and importance: Pachydermoperiostosis is a syndrome characterised by the triad of pachydermia, digital clubbing and periostosis of long bones and its scarce incidence and similarity in clinical features with acromegaly makes the diagnosis challenging. The elevated PGE2 levels have been hypothesised as one of its mechanisms and therapies have been targeted to inhibit this prostaglandin. Case presentation: A 25-year-old man with no comorbidities presented to OPD with 10-year history of bilateral pain and swelling of hands and feets associated with hyperhidrosis, grade IV clubbing and marked skin thickening on his forehead. X-ray revealed hyperostosis of metacarpals, proximal and middle phalanges and periosteal bone formation with cortical thickening of ankle joint. Tests done to rule out differentials such as thyroid acropachy, acromegaly, psoriatic arthritis were normal and clinical diagnosis of pachydermoperiostosis, a rare genetic disease characterised by pachyderma, digital clubbing, and periostosis was made. Clinical discussion: The patient was managed conservatively with Etoricoxib for six months on a follow-up basis. The symptoms were improving and a repeat X-ray showed partial improvement of soft tissue thickening and periostosis. Conclusion: Pachydermoperiostosis is a rare diagnosis with no clear consensus on management approach. Its management with selective COX-2 inhibitors such as Etoricoxib should be considered but its long term effects should be studied further.

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