Disclosures: Justin M. Leasure, MD: No financial relationships or conflicts of interest

Case Diagnosis: Degenerative joint disease (DJD) secondary to hypertrophy of tissues due to excessive growth hormone (GH)

Case Description: A 39-year-old male with history of acromegaly due to GH-secreting pituitary macroadenoma status post (s/p) multiple transsphenoidal partial resections and radiation presented to clinic for evaluation of chronic right ankle pain with remote fracture s/p open reduction internal fixation, left knee pain, left shoulder pain, and low back pain. Pain was exacerbated with activity and associated with swelling and mechanical symptoms. His height increased 3 inches over last year.

Setting: Tertiary Care Center Outpatient PM&R ClinicAssessment/

Results: Radiographs demonstrated effusions and preserved joint spaces. Right ankle MRI was consistent with post-traumatic arthritis and high-grade sprain. Left shoulder MRI was showed effusion, diffuse synovitis, rotator cuff tendinopathy, and labral tear. MRI left knee demonstrated synovial thickening, meniscal tears, and chondromalacia. His hormone levels were regulated with octreotide and cabergoline. His pain improved with corticosteroid injections, prolonged oral prednisone taper, NSAIDS, HEP, activity modification, and weight loss.

Discussion: Prevalence of acromegaly in the United States is estimated at 78 cases per million. 50-70% of these patients have joint pain and demonstrate arthropathy upon initial clinic presentation. Excessive GH leads to hypertrophy of cartilage, bone, and periarticular ligaments causing joint hypermobility which expedites early-onset DJD. Classic radiographic findings of osteoarthritis are not often seen initially in these patients. Primary treatment focuses on management of hormone levels and prevention of additional uncontrolled growth. Additional treatments include weight reduction, targeted home exercise program (HEP), bracing, assistive devices, injections, and possible surgical intervention.

Conclusion: This case underscores the importance of recognizing polyarthralgia and DJD in patients with acromegaly, as radiographic findings in these patients are often uncharacteristic of traditional DJD. The focus of treatment should be on optimizing hormone levels and is otherwise similar to the approach for other degenerative musculoskeletal conditions.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/polyarthralgia-in-an-adult-with-acromegaly-a-case-report/