Endocrine Abstracts

Charcot’s neuroarthropathy (CN) is a destructive disease of the bone and joints in patients with neuropathy, often found in people with diabetes. Despite being recognized for over 150 years, the early detection and therapeutic approach remain a challenge for physicians. We present a 40-years old women, non-smoker, who was referred to endocrinologist for poorly-controlled type 2 diabetes mellitus (T2DM) and swollen left ankle and foot with sharp, stabbing pain when standing or walking. She denied any local injury. Swelling and redness developed suddenly, with increased local warmth, pain and reduced sensation; she was treated with antibiotics, local antiseptic and anticoagulant therapy for 2 weeks but without any improvement. In past medical history, she had diabetic polyneuropathy for 6 years, proliferative retinopathy, hypertension and dyslipidemia. On hospital admission, the collapse of the midfoot arch (rocker bottom foot) was noted, together with intact skin surface and slightly more diminished pulse in left dorsalis pedis artery. Plain radiograph, CT scan and NMR of the left foot were performed and joint destruction and defragmentation with multiple bone fragments (debris-loose bodies), calcifications in soft tissue around navicular bone and calcaneus, dislocation and altered structure of navicular bone and old calcaneal fracture with irregularly formed callus pointed out to CN. The condition was further managed together with orthopedic doctor using conservative, non-surgical treatment (non-weightbearing) and protective orthosis. Since the first description of CN, the pursuit for the appropriate treatment continues. Anti-resorptive treatment with bisphosphonates (mostly zolendronic acid), calcitonin, recombinant parathyroid hormone (rhPTH) showed some improvement but there is no definitive evidence of better clinical outcomes. Although the sample sizes in studies were small, the published data regarding the use of denosumab are encouraging.