"Acromegalic arthropathy has different pathogenesis from primary osteoarthritis with chondral and synovial hypertrophy resulting in joint space widening; osteophytosis, and peri-articular soft tissue hypertrophy are also features 19. Common joints affected are the knees, hands, shoulders, and hips 19."
"In 2011 an AIP (aryl hydrocarbon-interacting protein gene) mutation was linked to acromegalic gigantism, found when studying four Irish families who displayed acromegalic and gigantism traits, known as childhood-onset acromegaly (i.e. when a child has gigantism which progresses through adulthood to acromegaly). It is said that there could be hundreds of carriers of this mutant gene, leading researchers to suggest that all childhood-onset acromegaly patients, especially those who have a family history of pituitary adenoma or acromegaly, should be screened and followed 8."
Expected headings
"Skull"
"Spine"
"Joints"
"Hands"
"Feet"
"Cardiac"
"Joint"
"Pituitary"
"Spine"
"Treatment"
"Prognosis"
"Acromegaly has an insidious onset and slow progression, and years usually elapse before a diagnosis is made 20. An eventual diagnosis is made only when the external features, especially those of the face, become noticeable or when the patient seeks medical assistance for visual problems, infertility or menstrual dysfunction, joint pain, or dental malocclusion 20."
"enlargement of the hands ('spade-shaped'), feet, nose, tongue, lips and ears"
"Evidence of vertebral body fractures, most commonly in the thoracolumbar region led researchers to state that radiographic screening of this region is indicated 4. Vertebral fracture without loss of bone mineral density is related to increased bone turnover markers seen in acromegaly 4. Loss of bone mineral density may also be seen, either as a direct effect or secondary to hypogonadism 18. Other features seen in the spine include a DISH-like appearance, posterior vertebral scalloping, increased vertebral height, elongation and widening of the vertebral bodies."
"Heel pad thickness may be increased. Although various cut off values have been described, >25 mm in males and >23 mm in females has been suggested, recognising that other pathologies, obesity and racial differences may contribute 23-25. It cannot be used to monitor successful treatment as it does not significantly reduce in thickness following treatment 22."
"Radiation therapy is also used in medical circumstances where other therapies have not been able to control tumour size, growth and production of excess growth hormone. Conventional fractionated radiotherapy carries an established risk of cerebrovascular morbidity and mortality and has largely been replaced by stereotactic radiosurgical techniques 20. The most frequently used radiation therapy for acromegaly is Gamma Knife which has not been shown to carry excess cerebrovascular risk in acromegaly 20,28. Its principal risks include eventual hypopituitarism and ophthalmoplegia and cranial nerve dysfunction, in cases where cavernous sinus targeting is required 28."
"Approximately 90-95% of cases are the result of growth hormone secreting (somatotroph) pituitary adenomas 10,20. The remaining 5% of cases are the result of ectopic production of growth hormone releasing hormone (GHRH) that result in somatotroph hyperplasia. These are typically from neuroendocrine tumours (e.g. pancreas, lungs, adrenal glands) or more rarely from GHRH secreting hypothalamic tumours (e.g. gangliocytomas) 20. True ectopic production of growth hormone, from pancreatic islet-cell tumours or lymphoma, has been reported but is rare 20. A very small number of cases result from the excessive use of exogenous growth hormone in athletes."
"Acromegalic arthropathy has different pathogenesis from primary osteoarthritis with chondral and synovial hypertrophy resulting in joint space widening; osteophytosis, and peri-articular soft tissue hypertrophy are also features 19. Common joints affected are the knees, hands, shoulders, and hips 19."