ACROMEGALIC ARTHROPATHY
Barkan Ariel
Division of Endocrinology & Metabolism,
University of Michigan, Medical Center, 3920 Taubman Center, Box 0354, Ann Arbor, MI
48109, USA.
Arthropathy is one of the most frequent and disabling complications of acromegaly.
Chronically elevated circulating levels of IGF-1 in conjunction with the locally-generated
autocrine/paracrine IGF-1 effect overgrowth of the articular cartilage with
subsequent altered joint geometry, cartilage and ligament trauma, ensuing
disorganized tissue repair and, finally, deformity of the joints. Both appendicular and
vertebral joints are affected, with knees, shoulders and lumbar spine being the most
frequent targets.
Conservative management with anti-inflammatory drugs and physical therapy is
effective, but hip replacement is often needed for terminal joint damage. Normalization of
GH output as evidenced by normal IGF-1 levels is the only pathogenetic therapy able to
stop the progression of arthropathy and to prevent long-term disability. |
