Approach to the patient with controlled acromegaly and acromegalic arthropathy: clinical diagnosis and management

Pelsma ICM, Kroon HM, Andela CD, van der Linden EMJ, Kloppenburg M, Biermasz NR, Claessen KMJA · Pituitary

States that arthropathy is two to nine times more prevalent in acromegaly than in the general population depending on the joint, that about 70 percent of patients in biochemical remission report joint symptoms and virtually all have radiographic changes, and that the radiographic phenotype is osteophytes with widened joint spaces reflecting cartilage hypertrophy, distinct from primary osteoarthritis. Progression continues in a considerable proportion of patients independent of remission, with higher age, higher baseline IGF-1 and longer disease as risk factors. Normalising growth hormone and IGF-1 is the cornerstone of management; no treatment of the arthropathy itself has been formally evaluated, and joint replacement is the last resort.

Population

Expert review from the Leiden pituitary centre, built around a 70-year-old woman with 14 years of growth-hormone excess and four joint replacements

Intervention

n/a

Comparator

n/a

Limitations

A narrative review and case report; the recommendations are the authors' clinical experience and guidelines for primary osteoarthritis, not trial evidence, as the paper says. It describes what sustained growth-hormone excess does to joints and tests no treatment. No funding or conflicts declared.