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Acromegalic Axial Arthropathy: A Clinical Case-Control Study

Departments of Clinical and Experimental Medicine, Sections of Rheumatology (R.S., D.D.B., F.M., P.O.), Molecular and Clinical Endocrinology and Oncology (R.P., P.M., G.L., A.C.), and Biomorphological and Functional Sciences (A.S.), "Federico II" University of Naples, 80131 Naples, Italy

Address all correspondence and requests for reprints to: Annamaria Colao, Department of Molecular and Clinical Endocrinology and Oncology, Federico II University of Naples, Via Sergio Pansini, 5 80131 Napoli, Italy. E-mail: colao{at}unina.it.

Arthropathy is the major cause of morbidity in acromegaly. To feature the spinal involvement, 54 patients with active acromegaly (27 men, 27 women; age range, 21–69 yr) and 54 sex-, age-, and body mass index-matched healthy controls were enrolled in this observational analytical prospective case-control study. A questionnaire to describe onset, duration, and severity of articular symptoms; rheumatological examination, including vertebral and chest mobility, Schober test, thorax expansion, and axial radiological study; and IGF-I, GH, insulin, and glucose level measurement (baseline and after an oral glucose tolerance test) was used to investigate the prevalence of arthropathy and correlate these findings with hormonal parameters. Axial arthropathy was found in 28 patients (52%) and 12 controls (22%; ² = 8.9; P = 0.003). In detail, spinal mobility was reduced in 30 patients (56%) and 10 controls (18%; ² = 14.3; P < 0.0001), thoracic cage was involved in six patients (11%), alterations of spinal profile were observed in 37 patients (68%) and 15 controls (28%; ² = 16.3; P < 0.0001), and increased L2 vertebra diameters were observed in 34 patients (63%) and none of the controls (² = 46.7; P < 0.0001). Narrowing and widening of L2–L3 disk space were found in 20 (37%) and seven (13%) patients, respectively. Features of diffuse idiopathic skeletal hyperostosis (DISH) were found in 11 patients (20%) and none of the controls (² = 10.1; P < 0.001). Disease duration was correlated with vertebral body height (P = 0.001) or intervertebral space height (P = 0.02), and lumbar mobility with thorax expansion (P = 0.004); DISH severity was correlated with basal (P = 0.04) and peak (P = 0.01) glucose levels after glucose load. In conclusion, chronic GH and IGF-I excess typically affects the axial skeleton with development of severe alterations of spine morphology and function until features of DISH occur. An early diagnosis of acromegaly is mandatory to reduce the severity of spine abnormalities as they were significantly higher in patients with longer disease duration.

This study was partially supported by a grant of the Italian Minister of Research and University in Rome (no. 2003068735).

Abbreviations: CV, Coefficient of variation; DISH, diffuse idiopathic skeletal hyperostosis; oGTT, oral glucose tolerance test.

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