Wydra Arnika, Stelmachowska-Banaś Maria, Czajka-Oraniec Izabella
Department of Endocrinology, Centre of Postgraduate Medical Education, Bielanski Hospital, Warsaw, Poland.
Reumatologia. 2023;61(4):248-255. doi: 10.5114/reum/169918. Epub 2023 Aug 31.
Hypersecretion of growth hormone (GH) is rare and typically results from a pituitary functional tumor - somatotropinoma. It leads to excessive linear bone growth and manifests as gigantism if occurring in childhood and adolescence, before the closure of epiphyses or as a acromegaly in adulthood. The excess of GH impacts bone metabolism directly as well as indirectly through increased insulin-like growth factor 1 (IGF-1). In acromegaly as a consequence of overproduction of GH and IFG-1 and the influence of these hormones on bone osteoblasts, bone metabolism, growth and density increase. However, bone turnover is accelerated causing impaired bone microstructure and strength, which may lead to increased risk of vertebral fractures irrespective of normal bone mineral density. Apart from the changes in bone architecture, acromegaly also results in a degenerative joint disease of a different nature than primary osteoarthritis. Moreover, acromegaly leads to cardiovascular, metabolic and respiratory complications, and thus significantly impairs the quality of life. In this review, authors summarize the pathophysiology, diagnosis, and treatment of bone and joint disease in acromegaly.
生长激素（GH）分泌过多较为罕见，通常由垂体功能性肿瘤——生长激素瘤引起。它会导致骨骼线性生长过度，如果在儿童期和青春期骨骺闭合前发生，表现为巨人症，在成年期则表现为肢端肥大症。过量的生长激素直接影响骨代谢，也通过增加胰岛素样生长因子1（IGF-1）间接影响骨代谢。在肢端肥大症中，由于生长激素和胰岛素样生长因子-1分泌过多以及这些激素对骨成骨细胞的影响，骨代谢、生长和密度增加。然而，骨转换加速会导致骨微结构和强度受损，这可能导致椎体骨折风险增加，无论骨矿物质密度是否正常。除了骨骼结构的变化外，肢端肥大症还会导致一种与原发性骨关节炎性质不同的退行性关节疾病。此外，肢端肥大症会导致心血管、代谢和呼吸并发症，从而显著损害生活质量。在这篇综述中，作者总结了肢端肥大症中骨与关节疾病的病理生理学、诊断和治疗。
