Paris Cité University, Department of physical medicine and rehabilitation, Hôpital Cochin - Assistance Publique- Hôpitaux de Paris, Paris, Île-de-France, France
Paris Cité University, Department of physical medicine and rehabilitation, Hôpital Cochin - Assistance Publique- Hôpitaux de Paris, Paris, Île-de-France, France.
BMJ Case Rep. 2024 Nov 14;17(11):e258545. doi: 10.1136/bcr-2023-258545.
A man in his early 50s presented with mechanical chronic pain and limitation of the active range of motion of the right shoulder. Imaging of the shoulder showed osteophytosis without joint space narrowing or cranial migration of the humeral head. He reported no history of trauma, dislocation arthropathy, clinical or standard biological evidence for septic or inflammatory arthritis, metabolic, haemophilic or endocrine-associated arthropathies. The second medical consultation revealed enlargement and infiltration of hands and feet. Consequently, we suspected acromegaly, which was confirmed by endocrinological diagnosis. Further, an MRI of the pituitary gland showed a sellar tumour. The patient's shoulder pain was related to undiagnosed acromegalic arthropathy leading to osteoarthritis and was treated by trans-sphenoidal exeresis of the somatotroph adenoma and a somatostatin analogue. In conclusion, acromegaly should be considered in patients with centred glenohumeral osteoarthritis, as an early diagnosis is essential to limit complications and preserve the quality of life.
一位 50 多岁的男性患者出现机械性慢性肩部疼痛和活动范围受限。肩部影像学检查显示骨赘形成，但无关节间隙变窄或肱骨头向颅侧迁移。他无创伤、脱位性关节炎、感染性或炎症性关节炎的临床或标准生物学证据、代谢性、血友病或内分泌相关关节病的病史。第二次会诊发现双手和双脚增大和浸润。因此，我们怀疑是肢端肥大症，内分泌学诊断证实了这一点。此外，垂体 MRI 显示蝶鞍肿瘤。患者的肩部疼痛与未确诊的肢端肥大性关节炎有关，导致骨关节炎，并通过经蝶窦切除生长激素腺瘤和生长抑素类似物进行治疗。总之，对于中心性肩关节炎患者应考虑肢端肥大症，早期诊断对于限制并发症和维持生活质量至关重要。
