Dons R F, Rosselet P, Pastakia B, Doppman J, Gorden P
Division of Endocrinology, Naval Hospital, Bethesda, Maryland.
Clin Endocrinol (Oxf). 1988 May;28(5):515-24. doi: 10.1111/j.1365-2265.1988.tb03686.x.
The medical records of 90 patients with acromegaly were reviewed. Arthralgias were noted in 76% of the patients with 17% having the onset of joint pain concomitant with the clinical onset of acromegaly. Of 47 patients followed prospectively for 5 or more years after pituitary irradiation, six (12.8%) were unaffected by arthralgias. A statistically higher mean baseline growth hormone level was found for the 19 (40.4%) radiotherapy patients who had severe and disabling arthropathy. Mean intervals between clinical onset of acromegaly and the development of arthropathic symptoms were shorter (4.1 years) for patients over 40 years of age and longer (9.7 years) for those under 31 years of age. Severely affected patients tended to have increased joint spaces in both weight-bearing and non-weight-bearing joints followed by a progressive decrease in joint spaces. Arthropathy is a common complication of acromegaly and may progress independently of a fall in growth hormone, induced by any form of treatment, once significant cartilage overgrowth develops. Cartilage overgrowth is a predisposing factor in the development of an arthropathy associated with the wide range of growth hormone levels characteristic of acromegaly.
回顾了90例肢端肥大症患者的病历。76%的患者出现关节痛，其中17%的患者关节疼痛与肢端肥大症的临床发病同时出现。在47例垂体放疗后接受5年或更长时间前瞻性随访的患者中，6例（12.8%）未受关节痛影响。在19例（40.4%）患有严重致残性关节病的放疗患者中，发现其平均基线生长激素水平在统计学上更高。40岁以上患者肢端肥大症临床发病与关节病症状出现之间的平均间隔较短（4.1年），而31岁以下患者则较长（9.7年）。严重受累患者的负重和非负重关节间隙往往增加，随后关节间隙逐渐减小。关节病是肢端肥大症的常见并发症，一旦出现明显的软骨过度生长，关节病可能独立于任何形式治疗引起的生长激素下降而进展。软骨过度生长是与肢端肥大症特有的广泛生长激素水平相关的关节病发展的一个易感因素。
