Rheumatic and bone disorders associated with acromegaly
- Lesley D Hordon, MD
Lesley D Hordon, MD
- Consultant in Rheumatology
- University of Leeds, United Kingdom
- Section Editors
- Peter H Schur, MD
Peter H Schur, MD
- Editor-in-Chief — Rheumatology
- Section Editor — Basic Science
- Professor of Medicine
- Harvard Medical School
- Marc K Drezner, MD
Marc K Drezner, MD
- Section Editor — Bone Disease
- Professor of Medicine
- University of Wisconsin Medical School
- Peter J Snyder, MD
Peter J Snyder, MD
- Editor-in-Chief — Endocrinology
- Section Editor — Pituitary Disease; Male Reproductive Endocrinology
- Professor of Medicine
- University of Pennsylvania School of Medicine
Acromegaly is a rare disorder characterized by excess secretion of growth hormone (GH) and its principle mediator, insulin-like growth factor (IGF)-1. Rheumatic problems are frequently seen in acromegaly including an arthropathy, which can be severe and disabling; carpal tunnel syndrome, which is often reversible; and a peripheral neuropathy . These findings may, in some cases, be a prominent initial sign of acromegaly. Acromegaly should be remembered as a rare but important cause of osteoarthritis (OA), particularly if OA is premature or associated with carpal tunnel syndrome.
The rheumatologic and bone disorders associated with acromegaly are reviewed here. The causes, other clinical manifestations, diagnosis, and treatment of acromegaly are presented separately. (See "Causes and clinical manifestations of acromegaly" and "Diagnosis of acromegaly" and "Treatment of acromegaly".)
Joint and spine disorders, most likely due to acceleration of the normal growth process, are common in acromegaly and may dominate the clinical picture.
Pathophysiology — Growth hormone (GH) and insulin-like growth factor (IGF)-1 are essential for normal growth, differentiation, and repair of cartilage and bone. Excess GH leads to a form of osteoarthritis (OA). A mechanism has been proposed to explain this process based upon in vitro studies assessing the effects of GH and IGF-1 on cartilage and connective tissue .
●Excess GH and IGF-1 cause proliferation of articular chondrocytes and increased matrix production. This leads to thickened articular cartilage and widening of the joint spaces.
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