Endocrine Abstracts

Background: Acromegaly is a chronic endocrine disease characterized by excessive secretion of somatotropic hormone (GH), which in turn leads to increased secretion of insulin-like growth factor 1 (IGF-1) in the liver. Many cells in the body are targets for these hormones. Excess of GH, in the vast majority of cases caused by hormone-producing pituitary adenoma, and IGF-1 leads to cellular and tissue growth of practically all organs and systems, including the bone and joint apparatus.

Case presentation: Patient A., 56 years old, since 2021 was observed for diabetes mellitus by an endocrinologist, subsequently the doctor paid attention to the enlargement of feet, joint pains. Examinations showed GH, IGF-1 elevation, and pituitary adenoma was visualized on MRI which led to diagnosis of acromegaly. In March 2023 a transnasal adenomectomy was performed. A dynamic examination after 6 months confirmed the absence of remission of acromegaly - IGF-1 498.5 ng/ml (82-283), and therefore therapy with octreotide 20 mg once every 28 days was initiated. During the examination, attention was drawn to complaints of pain in large joints, according to the results of a blood test: rheumatoid factor 37.7 IU/ml (0-30), antistreptolysin O 50 IU/ml (0-200), C-reactive protein 1.5 mg/l (0.1-5). Consulted with a rheumatologist, taking into account the clinical picture (Raynaud’s phenomenon, swelling of the hands, arthritis, arthralgia and myalgia) and laboratory and instrumental examination (immunological disorders, primary muscular process without exacerbation according to ENMG, synovitis according to ultrasound of the hands), the diagnosis was verified - mixed connective tissue disease tissues: arthritis, arthralgia, proximal muscle weakness, swelling of the hands, Raynaud’s phenomenon, Gottron’s papules, immunological disorders (antinuclear factor 1/2560, AT to RNP-70 >300.0, rheumatoid factor 85.0). Due to the presence of articular syndrome, methotrexate 15 mg/week and methylprednisolone 8 mg/day were initiated. During treatment, the patient noted a significant decrease in joint pain.

Conclusions: Thus, the presented clinical case emphasizes the importance of differential diagnosis of articular syndrome in acromegaly at the initial stage, since the identification of an immunoinflammatory rheumatic disease requires a completely different tactic that helps improve the patient’s well-being and relieve pain. Particular attention should be paid to patients who continue to have joint pain after achieving biochemical remission of acromegaly. In this regard, it is necessary not only to carry out a differential diagnosis of acromegalic arthropathy and rheumatological diseases, but also to provide multidisciplinary monitoring, in particular by a rheumatologist and an endocrinologist.