Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey.
Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey.
Pituitary. 2020 Aug;23(4):338-346. doi: 10.1007/s11102-020-01037-z.
Although it is well known that acromegaly causes enlargement in the extremities, studies investigating the effects of acromegaly on tendons, muscles and soft tissue are limited. The aims of our study were to investigate tendons, the presence of enthesitis, soft tissue, muscle groups in terms of thickness and pennation angle (PA) which is an indicator of microstructure and strength of the muscle, of the lower extremities.
Thirty-nine patients with acromegaly and thirty-nine healthy control subjects similar for age, sex and body mass index were enrolled. Lower extremity tendons, skin, muscle groups were evaluated by ultrasound.
The thicknesses of heel skin, heel pad, plantar fascia and Achilles tendon were higher in acromegaly than the control group (p < 0.05). The incidence of Achilles enthesitis were increased in the acromegaly group (p < 0.05). The thicknesses of the gastrocnemius medial head, vastus medialis, lateralis muscles for both sides and the left rectus femoris muscle were found to be lower in the acromegaly patients than controls (p < 0.05). However, thicknesses of vastus intermedius, gastrocnemius lateral head and soleus were similar between the acromegaly and control groups (p > 0.05). PA values of the right and left vastus medialis and the right vastus lateralis were found to be decreased in the acromegaly group (p < 0.05). Myostatin levels were lower in acromegaly group (p < 0.05).
Acromegaly may cause to an increase in tendon and soft tissue thickness, enthesitis formation, decrease in the thickness of some muscles, and deterioration in microstructures in lower extremity.
尽管肢端肥大症会导致四肢增大已广为人知，但研究肢端肥大症对肌腱、肌肉和软组织影响的研究有限。我们研究的目的是调查下肢的肌腱、肌腱末端病的存在、软组织、肌肉群的厚度和羽毛角（PA），PA 是肌肉微观结构和强度的一个指标。
共纳入 39 例肢端肥大症患者和 39 例年龄、性别和体重指数相匹配的健康对照组。下肢肌腱、皮肤、肌肉群通过超声进行评估。
与对照组相比，肢端肥大症患者的足跟皮肤、足跟垫、足底筋膜和跟腱厚度更高（p<0.05）。肢端肥大症组的跟腱附着点炎发病率升高（p<0.05）。与对照组相比，肢端肥大症患者的双侧腓肠肌内侧头、股四头肌内侧、外侧肌和左侧股直肌厚度较低（p<0.05）。然而，股中间肌、腓肠肌外侧头和比目鱼肌的厚度在肢端肥大症和对照组之间相似（p>0.05）。右侧和左侧股四头肌内侧和右侧股外侧肌的 PA 值在肢端肥大症组中降低（p<0.05）。肢端肥大症组的肌肉生长抑制素水平较低（p<0.05）。
肢端肥大症可能导致肌腱和软组织厚度增加、肌腱末端病形成、某些肌肉厚度减少以及下肢微观结构恶化。
