Rheumatologic Manifestation of Acromegaly - Causes, Symptoms, Diagnosis, and Treatment

Introduction:

Acromegaly is a hormonal disorder caused by the pituitary gland producing too much growth hormone in a person. Excessive growth hormone causes bones to grow. In childhood, this leads to excessive height and is called gigantism. However, height does not change after adulthood. Instead, the enlargement of bone is limited to the bones of the hands, feet, and face, called acromegaly. Because acromegaly is rare and changes in the body occur slowly over the years, the condition can take a long time to be recognized. When left untreated, high levels of growth hormone can affect various other parts of the body other than bones. This can lead to serious and sometimes life-threatening health problems. Rheumatoid disease is a term that refers to arthritis and various other conditions that affect the joints, muscles, tendons, bones, and ligaments (arthritis refers to conditions that primarily affect the joints). If not treated properly, rheumatic diseases such as osteoarthritis can lead to severe joint pain due to the destruction of cartilage, the hard and soft tissue that protects joints.

What Is Rheumatologic Manifestation of Acromegaly?

Acromegaly is associated with multi-organ manifestations, including the heart, colon, skin, bones, and joints. Both weight-bearing and non-weight-bearing joints, such as shoulders, wrists, knees, hips, and spine, are affected. In addition to arthropathy (joint disease), patients with active and controlled acromegaly are at an increased risk of vertebral features.

What Are the Causes of the Rheumatologic Manifestation of Acromegaly?

Growth hormone (GH) and insulin-like growth factor (IGF) 1 are important for normal growth, differentiation, and repair of bone and cartilage. However, excess levels of GH and IGF-1, which are hallmarks of acromegaly, cause arthropathy that resembles osteoarthritis (OA) but with several different features. The pathophysiology of the rheumatologic manifestation of acromegaly is not fully understood.

What Are the Risk Factors for the Rheumatologic Manifestation of Acromegaly?

Common risk factors for developing acromegaly are related to risk factors for developing pituitary gland tumors. Pituitary gland tumor is the most common reason for acromegaly.

Common risk factors for developing acromegaly include:

• Family history of pituitary gland tumor.

• McCann-Albright syndrome (disorder leading to fibrous bones).

• Lung cancer.

• Adrenal gland tumor.

• Women in early menopause.

• Surgical menopause.

• First pregnancy in a woman of young age.

What Are the Symptoms of the Rheumatologic Manifestation of Acromegaly?

The symptoms of rheumatologic manifestations of acromegaly are listed below:

• Enlarged hands.

• Enlarged feet.

• Enlarged jaw (prognathism) and tongue.

• Enlarged facial bones.

• Limited joint mobility.

• Joint pain.

• Swelling of the bony areas around a joint.

• Carpal tunnel syndrome.

• Swelling, redness, and pain along with widened fingers or toes due to skin overgrowth.

• Decreased muscle strength (weakness).

How Is Rheumatologic Manifestation of Acromegaly Diagnosed?

After a physical examination, the doctor may recommend the following tests:

• IGF-1 Measurement - After an overnight fast, the doctor will require a blood sample to measure the level of IGF-1 in the blood. Elevated IGF-1 levels indicate acromegaly.

• Imaging Tests - The doctor may recommend imaging tests such as magnetic resonance imaging (MRI) to determine the location and size of pituitary tumors. If no pituitary tumor is seen, the doctor may advise other imaging tests to look for tumors elsewhere.

• Growth Hormone Suppression Test - This is the best way to confirm the diagnosis of acromegaly. This test measures blood GH levels both before and after taking a sugar preparation (glucose). In someone who doesn't have acromegaly, drinking glucose usually lowers her GH levels. However, if you have acromegaly, the GH levels tend to remain high.

What Is the Treatment for the Rheumatologic Manifestation of Acromegaly?

The treatment plans depend on the location and size of the tumor, severity of symptoms, age, and general health of an individual. Listed below are some ways of treatment therapy for acromegaly and its rheumatological manifestations:

1. Surgery - Doctors can remove most pituitary tumors using a procedure called transsphenoidal surgery. In this operation, a surgeon removes a tumor from the pituitary gland through the nose.

2. Medications - Drugs that reduce the production of growth hormone or block the action of growth hormone. Also, anti-inflammatory drugs like Naproxen sodium are prescribed to help with joint pains .

3. Radiation - If the pituitary gland tumor is not successfully removed by surgery, then it is done by treated with the help of radiation therapy. Radiation therapy destroys any remaining tumor cells and slowly reduces GH levels. It sometimes takes years for this treatment to significantly improve the symptoms of acromegaly and its rheumatological manifestations.

4. Steroid Therapy - Corticosteroid medications reduce inflammation and pain and reduce joint damage. A commonly prescribed steroid medication is Prednisone.

5. Physical Therapy - A physical therapist may help improve joint mobility.

6. Joint Surgery for Mobility - To improve joint mobility, doctors may use the following types of surgeries to improve mobility of the joints:

• Synovectomy - Surgery to remove the lining of the inflamed joint (synovium) can help relieve pain and improve joint flexibility.

• Total Joint Replacement - In joint replacement surgery, a surgeon removes the damaged part of the joint and inserts a metal and plastic prosthesis.

• Tendon Repair - Inflammation and joint damage can cause the tendons around the joint to loosen or tear. The surgeon may be able to repair the tendons around the joint.

• Common Fusion - Surgical immobilization of the joint may be recommended for joint stabilization or realignment and pain relief when joint replacement is not an option.

What Are the Complications of Rheumatologic Manifestation of Acromegaly?

When left untreated rheumatologic manifestation of acromegaly may cause the following:

• Joint immobility

• carpal tunnel syndrome

• Increased risk of cancerous tumors

• Compression or fracture of the spinal cord

• Severe joint pain.

How to Prevent Rheumatologic Manifestation of Acromegaly?

Unfortunately, acromegaly is not preventable, but the following steps can be taken to help get a better outcome for this condition:

• Regular walks.

• Eating a balanced diet.

• Quit smoking.

• Avoid alcohol.

Conclusion:

Acromegaly is a chronic endocrine disorder caused by hypersecretion of growth hormone (GH) and insulin-like growth factor I (IGF-1) by pituitary tumors. Growth hormone deficiency has been implicated in the development of bone loss and osteoporosis in adults, but the effects of excess growth hormone on bone are unknown and uncertain. Acromegaly is known to cause rheumatological joint conditions such as arthropathy. It can further cause severe bone pain and joint immobility. Early intervention may lead to improved outcomes for this condition and a better quality of life.