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van Trigt VR, Pelsma ICM, Kroon HM, Pereira AM, van der Meulen C, Kloppenburg M, Biermasz NR, Claessen KMJA. Low prevalence of neuropathic-like pain symptoms in long-term controlled acromegaly. Pituitary 2022; 25:229-237. [PMID: 34687408 PMCID: PMC8894222 DOI: 10.1007/s11102-021-01190-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Pain is a common symptom of acromegaly, impairing health-related quality of life (HR-QoL) significantly despite long-term disease remission. Neuropathic-like pain (NP-like) symptoms are invalidating, with great impact on HR-QoL. Studies characterizing or investigating the etiology of pain in acromegaly are scarce. Therefore, we aimed to assess NP-like symptoms in a cohort of controlled acromegaly patients. METHODS Forty-four long-term controlled acromegaly patients (aged 62.6 ± 12.6 years; 56.8% female) were included in this cross-sectional study. NP-like symptoms were assessed using the validated painDETECT questionnaire. Patients were divided in three probability-based NP-like symptoms categories based on the total score (range 0-35): unlikely (≤ 12), indeterminate (13-18) and likely (≥ 19). HR-QoL (physical component score (PCS), and mental component score (MCS)), and self-reported pain were assessed using Short Form-36 (SF-36). Potential risk factors were determined using linear regression analyses. RESULTS Self-reported pain was reported by 35 patients (79.5%). Likely NP-like symptoms were present in 4/44 patients (9.1%), and indeterminate NP-like symptoms in 6/44 patients (13.6%). All patients with likely NP-like symptoms were female. Higher painDETECT scores were negatively associated with HR-QoL (PCS: r = - 0.46, P = 0.003; MCS: r = - 0.37, P = 0.018), and SF-36 pain scores (r = - 0.63, P < 0.0001). Female sex was a risk factor for NP-like symptoms. CONCLUSIONS Pain was prevalent in controlled acromegaly patients, whereas NP-like symptoms were relatively infrequent, and only observed in females. NP-like symptoms were associated with lower HR-QoL in acromegaly. Since specific analgesic therapy is available, awareness for characterization, increased understanding, and clinical trials regarding neuropathic pain identification and treatment in acromegaly patients are warranted.
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Affiliation(s)
- Victoria R van Trigt
- Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors Leiden, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Iris C M Pelsma
- Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors Leiden, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Herman M Kroon
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Alberto M Pereira
- Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors Leiden, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Coen van der Meulen
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nienke R Biermasz
- Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors Leiden, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Kim M J A Claessen
- Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors Leiden, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
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Omma T, Tunc AR, Fırat SN, Taskaldıran I, Culha C, Ersoz Gulcelik N. Pedabarography May Play a Role in Foot Plantar Scanning in Acromegaly. Int J Clin Pract 2022; 2022:9882896. [PMID: 35685582 PMCID: PMC9158791 DOI: 10.1155/2022/9882896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/05/2022] [Accepted: 04/11/2022] [Indexed: 11/17/2022] Open
Abstract
AIMS Acromegaly is associated with symptoms in many organs, including the heart, colon, skin, bones, and many joints. Patients with long-term treatment or biochemical control still suffer from acromegaly arthropathy (AA). Primarily, the weight-bearing joints of the lower extremity are affected and at last deformation emerges. The aim of this study is to detect the changes in the feet with pedabarography in patients with acromegaly. MATERIALS AND METHODS Nineteen patients with acromegaly (4 males and 15 females) and 13 healthy controls (1 male and 12 females) were included in the study (p=0.31). There was no difference between acromegaly patients and controls in terms of gender, age, and BMI; median age and BMI were (54 (20-67) vs. 52 (30-58), p=0.85) and (32.5 (20.3-42.7) vs. 29.5 (22.4-38.6), p=0.93), respectively. Static plantar pressures of bilateral foot of all participants in the standing position were measured by pedabarography. RESULTS In pedabarographic analysis, there were only significant difference in rearfoot surface right and rearfoot surface left (p=0.04 and p=0.01), respectively. The mean of the right rearfoot surface (43.5 cm2 vs. 36.6 cm2) and the mean of the left rear foot surface were higher than the controls (47.4 cm2 vs. 40.2 cm2). Forefoot surface, forefoot load, forefoot weight ratio, rearfoot load, total foot surface, total load, total peak pressure, and total average pressure were higher in left foot in both groups, but there was no difference between the two groups. CONCLUSION In our study, there was a significant difference between acromegaly patients and healthy controls, only on the right rarefoot surface and the left rarefoot surface, and was higher on the left in both groups. These patients often experience changes in the hindfoot and heel, and foot surface area and pressure distribution may vary. Early diagnosis and proper treatment of the disease can prevent the development of complications and improve the quality of life. Foot scanning using pedabarography in the management of AA is a useful tool that can be used to manufacture customized orthopedic insoles and ergonomic shoe designs to prevent irreversible damage and reduce overload and lower extremity pain.
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Affiliation(s)
- Tulay Omma
- Department of Endocrinology and Metabolism, University of Health Sciences, Ankara Training and Research Hospital, 06230 Ankara, Turkey
| | - Azize Reda Tunc
- Department of Physiotherapy, Lokman Hekim University, Faculty of Health Sciences, 06510 Ankara, Turkey
| | - Sevde Nur Fırat
- Department of Endocrinology and Metabolism, University of Health Sciences, Ankara Training and Research Hospital, 06230 Ankara, Turkey
| | - Isılay Taskaldıran
- Department of Endocrinology and Metabolism, University of Health Sciences, Ankara Training and Research Hospital, 06230 Ankara, Turkey
| | - Cavit Culha
- Department of Endocrinology and Metabolism, University of Health Sciences, Ankara Training and Research Hospital, 06230 Ankara, Turkey
| | - Nese Ersoz Gulcelik
- Department of Endocrinology and Metabolism, University of Health Sciences, Gulhane Training and Research Hospital, 06010 Ankara, Turkey
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3
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de Alegria SG, Kasuki L, Gadelha M, Lopes AJ. The Glittre Activities of Daily Living Test in patients with acromegaly: Associations with hand function and health-related quality of life. J Back Musculoskelet Rehabil 2021; 34:441-451. [PMID: 33492273 DOI: 10.3233/bmr-200089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Musculoskeletal disorders in acromegaly compromise upper and lower limb activity. Corresponding changes can be better assessed by a functional capacity test incorporating multitasking, such as the Glittre Activities of Daily Living Test (GA-T). OBJECTIVES To evaluate functional capacity in adults with acromegaly using the GA-T and to correlate functional capacity with hand function and health-related quality of life. METHODS The GA-T was applied to 36 patients with acromegaly and an equal number of healthy individuals. Additionally, participants completed the Acromegaly Quality of Life (AcroQoL) questionnaire and underwent a chronic pain assessment using a map of the human body, a hand function evaluation using the Cochin Hand Functional Scale (CHFS), and a handgrip strength test. RESULTS Relative to the comparison group, patients with acromegaly required more time to perform the GA-T, showed worse hand function, and reported that squatting to accomplish shelving tasks was the major difficulty. GA-T time was correlated with the AcroQoL global score, handgrip strength, and the CHFS (rs=-0.487, p= 0.002; rs=-0.369, p= 0.026; rs= 0.538, p= 0.0007, respectively). CONCLUSIONS Patients with acromegaly exhibited a reduced functional capacity as assessed by the GA-T. Additionally, an association was identified between the total GA-T time and both hand function and quality of life.
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Affiliation(s)
| | - Leandro Kasuki
- Neuroendocrinology Research Centre/Endocrinology Section, Medical School and Clementino Fraga Filho University Hospital, Federal University of the Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.,Neuroendocrine Unit, Paulo Niemeyer State Brain Institute, Secretary of State for Health of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Monica Gadelha
- Neuroendocrinology Research Centre/Endocrinology Section, Medical School and Clementino Fraga Filho University Hospital, Federal University of the Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.,Neuroendocrine Unit, Paulo Niemeyer State Brain Institute, Secretary of State for Health of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Agnaldo José Lopes
- Rehabilitation Sciences, Augusto Motta University Center (UNISUAM), Rio de Janeiro, Brazil.,School of Medical Sciences, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
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4
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Fatti LM, Cangiano B, Vitale G, Persani L, Mantovani G, Sala E, Arosio M, Maffei P, Dassie F, Mormando M, Giampietro A, Tanda L, Masiello ER, Nazzari E, Ferone D, Corbetta S, Passeri E, Guaraldi F, Grottoli S, Cannavò S, Torre MLT, Soranna D, Zambon A, Cavagnini F, Scacchi M. Arthropathy in acromegaly: a questionnaire-based estimation of motor disability and its relation with quality of life and work productivity. Pituitary 2019; 22:552-560. [PMID: 31032537 DOI: 10.1007/s11102-019-00966-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE Arthropathy is a common and disabling complication of acromegaly. Since in this condition radiological findings rarely correspond to functional impairment, we elected to quantify in a large cohort of acromegalic patients: the degree of motor disability compared with data from general population, the impact of joint involvement on quality of life and work productivity, and to look for associated factors. METHODS In 211 acromegalic patients, 131 with controlled disease and 80 with active disease, eight validated scales were used to evaluate the (i) prevalence and distribution of arthropathy, (ii) degree of motor disability and joint symptoms (VAS, AIMS symptoms and WOMAC), (iii) quality of life (AcroQoL and PASQ) and work capability (WPAI:GH) as consequences of joint complications. RESULTS Using the WOMAC questionnaire, for which population based normative values are available, a significantly higher prevalence and severity of motor disability was detected in acromegalics compared to the general population from literature. The results provided by the different questionnaires turned out to be highly concordant. All measures of motor disability correlated both with impaired quality of life and motor disability and were worse in females and in patients with higher BMI. CONCLUSIONS The questionnaires VAS, AIMS symptoms, and WOMAC (this latter both as a whole and with its functionality subscale), with their scores, proved to be the most adequate tools to evaluate motor disability and its consequences on both quality of life and work productivity in acromegaly. Female gender and higher BMI are associated with worse articular symptoms.
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Affiliation(s)
- L M Fatti
- Division of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - B Cangiano
- Division of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - G Vitale
- Division of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - L Persani
- Division of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - G Mantovani
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Endocrine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - E Sala
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Endocrine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Arosio
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Endocrine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - P Maffei
- Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - F Dassie
- Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - M Mormando
- Pituitary Unit, Section of Endocrinology, Department of Internal Medicine, Catholic University, 'A. Gemelli' University Hospital, Rome, Italy
| | - A Giampietro
- Pituitary Unit, Section of Endocrinology, Department of Internal Medicine, Catholic University, 'A. Gemelli' University Hospital, Rome, Italy
| | - L Tanda
- Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
| | - E R Masiello
- Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
| | - E Nazzari
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
| | - D Ferone
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
| | - S Corbetta
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Endocrinology and Diabetology Service, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - E Passeri
- Endocrinology and Diabetology Service, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - F Guaraldi
- Pituitary Unit, Department of Biomedical and Neuromotor Sciences, IRCCS Institute of Neurological Sciences of Bologna, University of Bologna, Bologna, Italy
| | - S Grottoli
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - S Cannavò
- Department of Human Pathology, University of Messina, Messina, Italy
- Endocrine Unit, University Hospital of Messina, Messina, Italy
| | - M L T Torre
- Department of Human Pathology, University of Messina, Messina, Italy
| | - D Soranna
- Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - A Zambon
- Division of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - F Cavagnini
- Istituto Auxologico Italiano IRCCS, Center for Biomedical Research and Technology, Cusano Milanino, Milan, Italy
| | - M Scacchi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
- Division of General Medicine, Istituto Auxologico Italiano, IRCCS, Ospedale S. Giuseppe, Strada Cadorna 90, 28824, Località Piancavallo, Oggebbio-Verbania, Italy.
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Gadelha MR, Kasuki L, Lim DST, Fleseriu M. Systemic Complications of Acromegaly and the Impact of the Current Treatment Landscape: An Update. Endocr Rev 2019; 40:268-332. [PMID: 30184064 DOI: 10.1210/er.2018-00115] [Citation(s) in RCA: 197] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 07/26/2018] [Indexed: 12/19/2022]
Abstract
Acromegaly is a chronic systemic disease with many complications and is associated with increased mortality when not adequately treated. Substantial advances in acromegaly treatment, as well as in the treatment of many of its complications, mainly diabetes mellitus, heart failure, and arterial hypertension, were achieved in the last decades. These developments allowed change in both prevalence and severity of some acromegaly complications and furthermore resulted in a reduction of mortality. Currently, mortality seems to be similar to the general population in adequately treated patients with acromegaly. In this review, we update the knowledge in complications of acromegaly and detail the effects of different acromegaly treatment options on these complications. Incidence of mortality, its correlation with GH (cumulative exposure vs last value), and IGF-I levels and the shift in the main cause of mortality in patients with acromegaly are also addressed.
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Affiliation(s)
- Mônica R Gadelha
- Neuroendocrinology Research Center/Endocrine Section and Medical School, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Neuroendocrine Section, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil.,Neuropathology and Molecular Genetics Laboratory, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
| | - Leandro Kasuki
- Neuroendocrinology Research Center/Endocrine Section and Medical School, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Neuroendocrine Section, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil.,Endocrine Unit, Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil
| | - Dawn S T Lim
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | - Maria Fleseriu
- Department of Endocrinology, Diabetes and Metabolism, Oregon Health and Science University, Portland, Oregon.,Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon.,Northwest Pituitary Center, Oregon Health and Science University, Portland, Oregon
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6
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The risks of overlooking the diagnosis of secreting pituitary adenomas. Orphanet J Rare Dis 2016; 11:135. [PMID: 27716353 PMCID: PMC5052978 DOI: 10.1186/s13023-016-0516-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 09/16/2016] [Indexed: 01/06/2023] Open
Abstract
Secreting pituitary adenomas that cause acromegaly and Cushing’s disease, as well as prolactinomas and thyrotroph adenomas, are uncommon, usually benign, slow-growing tumours. The rarity of these conditions means that their diagnosis is not familiar to most non-specialist physicians. Consequently, pituitary adenomas may be overlooked and remain untreated, and affected individuals may develop serious comorbidities that reduce their quality of life and life expectancy. Because many signs and symptoms of pituitary adenomas overlap with those of other, more common disorders, general practitioners and non-endocrinology specialists need to be aware of the “red flags” suggestive of these conditions. A long duration of active disease in patients with secreting pituitary adenomas is associated with an increased risk of comorbidities and reduced quality of life. Appropriate treatment can lead to disease remission, and, although some symptoms may persist in some patients, treatment usually reduces the incidence and severity of comorbidities and improves quality of life. Therefore, correct, early diagnosis and characterization of a pituitary adenoma is crucial for patients, to trigger timely, appropriate treatment and to optimize outcome. This article provides an overview of the epidemiology of hormonal syndromes associated with pituitary adenomas, discusses the difficulties of and considerations for their diagnosis, and reviews the comorbidities that may develop, but can be prevented, by accurate diagnosis and appropriate treatment. We hope this review will help general practitioners and non-endocrinology specialists to suspect secreting pituitary adenomas and refer patients to an endocrinologist for confirmation of the diagnosis and treatment.
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7
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Abstract
Ultimately, almost all patients who are appropriately treated for pituitary tumours enter a chronic phase with control or cure of hormonal excess, adequate treatment of pituitary insufficiency and relief of mass effects. This phase is associated with improvement of initial signs and symptoms, but also with the persistent consequences of the initial disease and associated treatments. Pituitary insufficiency is a common denominator in many of these patients, and is associated with a reduction in quality of life, despite adequate endocrine substitution. Hypothalamic dysfunction can be present in patients previously treated for visual impairments caused by large suprasellar adenomas, or craniopharyngiomas. In addition to hypopituitarism, these patients can have multisystem morbidities caused by altered hypothalamic function, including weight gain and disturbed regulation of sleep-wake cycles. Mortality can also be affected. Patients cured of Cushing disease or acromegaly have chronic multisystem morbidities (in the case of Cushing disease, also affecting mortality) caused by irreversible effects of the previous excesses of cortisol in Cushing disease and growth hormone and insulin-like growth factor 1 in acromegaly. In addition to early diagnosis and treatment of pituitary tumours, research should focus on the amenability of these chronic post-treatment syndromes to therapeutic intervention, to improve quality of life and clinical outcomes.
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Affiliation(s)
- Johannes A Romijn
- Department of Medicine, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, Netherlands
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8
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Three-dimensional soft tissue analysis of the hand: a novel method to investigate effects of acromegaly. EUROPEAN JOURNAL OF PLASTIC SURGERY 2016; 39:429-434. [PMID: 27932856 PMCID: PMC5119839 DOI: 10.1007/s00238-016-1217-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 06/13/2016] [Indexed: 11/24/2022]
Abstract
Background Acral overgrowth is a highly common clinical sign in patients with active acromegaly. To what extent this overgrowth persists after long-term remission of acromegaly is largely unknown. Using the new imaging technique of three-dimensional (3D) stereophotogrammetry, it is possible to accurately investigate soft tissue changes of the hand. The aim of the recent study was to compare the 3D soft tissue characteristics of the hands of patients in long-term remission of acromegaly to those of a healthy pair matched control group. Methods A case-control study was performed at a tertiary referral center. Twelve patients in remission of acromegaly (58 % male, mean age 58.3 years, mean BMI 29.6 kg/m2) were compared to twelve age-, gender-, ethnicity-, and BMI-matched control subjects. Of each individual, 3D photographs of both hands were acquired and analyzed using a 3D computer software program. Results The patients in long-term remission of acromegaly have overgrowth of soft tissue of the hand compared to matched control subjects, with a larger length and width of the hand (p = 0.0025, p = 0.0017, respectively). Furthermore, the diameters measured at the proximal interphalangeal (PIP) joints of the individual fingers are larger in the acromegaly patients. Conclusions Significant soft tissue overgrowth of the hand persists in former acromegaly patients, even after long-term remission. Analysis of 3D hand photographs is an accurate and easy tool to evaluate the acral soft tissue patterns in acromegaly. Level of Evidence: Level III, diagnostic study.
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9
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Damman W, Kortekaas MC, Stoel BC, van 't Klooster R, Wolterbeek R, Rosendaal FR, Kloppenburg M. Sensitivity-to-change and validity of semi-automatic joint space width measurements in hand osteoarthritis: a follow-up study. Osteoarthritis Cartilage 2016; 24:1172-9. [PMID: 26876778 DOI: 10.1016/j.joca.2016.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 01/11/2016] [Accepted: 02/07/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess sensitivity-to-change and validity of longitudinal quantitative semi-automatic joint space width (JSW) measurements and to compare this method with semi-quantitative joint space narrowing (JSN) scoring in hand osteoarthritis (OA) patients. DESIGN Baseline and 2-year follow-up radiographs of 56 hand OA patients (mean age 62 years, 86% women) were used. JSN was scored 0-3 using the Osteoarthritis Research Society International atlas and JSW was quantified in millimetres (mm) in the second to fifth distal, proximal interphalangeal and metacarpal joints (DIPJs, PIPJs, MCPJs). Sensitivity-to-change was evaluated by calculating Standardized Response Means (SRMs). Change in JSW or JSN above the Smallest Detectable Difference (SDD) defined progression on joint level. To assess construct validity, progressed joints were compared by cross-tabulation and by associating baseline ultrasound variables with progression (using generalized estimating equations, adjusting for age and sex). RESULTS The JSW method detected statistically significant mean changes over 2.6 years (-0.027 mm (95%CI -0.01; -0.04), -0.024 mm (-0.01; -0.03), -0.021 mm (-0.01; -0.03) for DIPJs, PIPJs, MCPJs, respectively). Sensitivity-to-change was low (SRMs: 0.174, 0.168, 0.211, respectively). 9.1% (121/1336) of joints progressed in JSW, but 3.6% (48/1336) widened. 83 (6.2%) joints progressed in JSW only, 36 (2.7%) in JSN only and 37 (2.8%) in both methods. Progression in JSW showed weaker associations with baseline inflammatory ultrasound features than progression in JSN. CONCLUSIONS Assessment of progression in hand OA defined by JSW measurements is possible, but performs less well than progression defined by JSN scoring. Therefore, the value of JSW measurements in hand OA clinical trials remains questionable.
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Affiliation(s)
- W Damman
- Department of Rheumatology, Leiden University Medical Center (LUMC), Leiden, The Netherlands.
| | - M C Kortekaas
- Department of Rheumatology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - B C Stoel
- Division of Image Processing, Department of Radiology, LUMC, Leiden, The Netherlands
| | - R van 't Klooster
- Division of Image Processing, Department of Radiology, LUMC, Leiden, The Netherlands
| | - R Wolterbeek
- Department of Medical Statistics, LUMC, Leiden, The Netherlands
| | - F R Rosendaal
- Department of Clinical Epidemiology, LUMC, Leiden, The Netherlands
| | - M Kloppenburg
- Department of Rheumatology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
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10
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Claessen KMJA, Mazziotti G, Biermasz NR, Giustina A. Bone and Joint Disorders in Acromegaly. Neuroendocrinology 2016; 103:86-95. [PMID: 25633971 DOI: 10.1159/000375450] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 01/22/2015] [Indexed: 11/19/2022]
Abstract
Acromegaly is a chronic, progressive disease caused by a growth hormone (GH)-producing pituitary adenoma, resulting in elevated GH and insulin-like growth factor 1 concentrations. Following appropriate therapy (surgery, radiotherapy and/or medical treatment), many systemic GH-induced comorbid conditions improve considerably. Unfortunately, despite biochemical control, acromegaly patients suffer from a high prevalence of late manifestations of transient GH excess, significantly impairing their quality of life. In this overview article, we summarize the pathophysiology, diagnosis, clinical picture, disease course and management of skeletal complications of acromegaly, focusing on vertebral fractures and arthropathy.
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Affiliation(s)
- Kim M J A Claessen
- Department of Endocrinology and Metabolism, Leiden University Medical Center, Leiden, The Netherlands
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Abstract
Kavain, an extract from the shrub Piper Methysticum, was recently reported to modulate TNF-α expression in both human and mouse cells via regulation of LPS-Induced TNF-Alpha Factor (LITAF). The purpose of the present study was to define the molecular pathway(s) associated with Kavain effects on TNF modulation. In vitro studies using WT mouse primary macrophages showed that Kavain significantly reduced E.coli LPS-induced TNF-α production but this effect was almost abrogated in LITAF-/- and ERK2-/- cells. Therefore we reintroduced the ERK2 gene in ERK2-/- cells and partially restored E.coli LPS-induced LITAF-mediated TNF-α production. The translocation of LITAF into to nucleus was found to be dependent on ERK2 S206 residue. Kavain inhibits LITAF/TNF-α expression via dephosphorylation of ERK2 in response to E.coli LPS. Finally, in vivo, Kavain had a significant anti-inflammatory effect on wild type mice that developed Collagen Antibody Induced Arthritis (CAIA), but only a minor effect in ERK2-/- mice also affected by CAIA. Based on these findings, we concluded that ERK2 may be the kinase upstream of LITAF with its Serine residue 206 being crucial for the regulation of LPS-induced TNF-α.
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Affiliation(s)
- Xiaoren Tang
- Center for Anti-Inflammatory Therapeutics, Molecular & Cell Biology Department, Boston University Goldman School of Dental Medicine, Boston, MA, 02118 USA
| | - Salomon Amar
- Center for Anti-Inflammatory Therapeutics, Molecular & Cell Biology Department, Boston University Goldman School of Dental Medicine, Boston, MA, 02118 USA
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Claessen KM, Pereira AM, Biermasz NR. Outcome of complications in acromegaly patients after long-term disease remission. Expert Rev Endocrinol Metab 2015; 10:499-510. [PMID: 30298766 DOI: 10.1586/17446651.2015.1068116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Acromegaly patients suffer from pathologically high growth hormone (GH) and IGF-1 levels that in 99% of cases is due to a GH-producing pituitary adenoma. During active disease, GH excess is associated with a number of pathological conditions, such as hypertension, hypertrophic cardiomyopathy, sleep apnea, arthropathy, vertebral fractures and insulin resistance. After adequate treatment in the form of transsphenoidal surgery, radiotherapy, medical treatment or by a combination of these treatment modalities, several comorbid conditions improve considerably. However, despite long-term biochemical disease control, the prevalence of late manifestations of GH excess is high and significantly impair quality of life. In addition, there is evidence that adequate treatment is not able to normalize mortality risk in these patients. In this review, we critically evaluate the long-term consequences of acromegaly after treatment, focusing on comorbid conditions, quality of life and mortality. We also discuss ongoing challenges in the management of acromegaly patients.
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Affiliation(s)
| | - Alberto M Pereira
- a Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, The Netherlands
| | - Nienke R Biermasz
- a Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, The Netherlands
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13
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Giustina A, Chanson P, Kleinberg D, Bronstein MD, Clemmons DR, Klibanski A, van der Lely AJ, Strasburger CJ, Lamberts SW, Ho KKY, Casanueva FF, Melmed S. Expert consensus document: A consensus on the medical treatment of acromegaly. Nat Rev Endocrinol 2014; 10:243-8. [PMID: 24566817 DOI: 10.1038/nrendo.2014.21] [Citation(s) in RCA: 256] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
In March 2013, the Acromegaly Consensus Group met to revise and update guidelines for the medical treatment of acromegaly. The meeting comprised experts skilled in the medical management of acromegaly. The group considered treatment goals covering biochemical, clinical and tumour volume outcomes, and the place in guidelines of somatostatin receptor ligands, growth hormone receptor antagonists and dopamine agonists, and alternative modalities for treatment including combination therapy and novel treatments. This document represents the conclusions of the workshop consensus.
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Affiliation(s)
- Andrea Giustina
- Chair of Endocrinology, University of Brescia, via Biseo 17, 25100 Brescia, Italy
| | - Philippe Chanson
- Assistance Publique-Hôpitaux de Paris, Service d'Endocrinologie et des Maladies de la Reproduction, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, Paris, F 94275, France
| | - David Kleinberg
- Neuroendocrine Unit, New York University School of Medicine, Department of Veterans Affairs Medical Centre, 423 East 23rd Street, Room 16043W, New York, NY 10010, USA
| | - Marcello D Bronstein
- Neuroendocrine Unit, Division of Endocrinology and Metabolism, University of São Paulo Medical School, Avenue Dr. Eneas de Carvalho, 255, 7° Andar, Sala 7037, São Paulo, CEP 05403 000, Brazil
| | - David R Clemmons
- Department of Medicine, University of North Carolina, CB# 7170, 8024 Burnett-Womack, Chapel Hill, NC 27599, USA
| | - Anne Klibanski
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Aart J van der Lely
- Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, Netherlands
| | | | - Steven W Lamberts
- Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, Netherlands
| | - Ken K Y Ho
- Princess Alexandra Hospital, 199 Ipswich Road, Brisbane, QLD 4102, Australia
| | - Felipe F Casanueva
- Santiago de Compostela University and CIBERobn, Santiago de Compostela, E-15780, Spain
| | - Shlomo Melmed
- Department of Medicine, Cedars-Sinai Medical Center, Room 2015, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA
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15
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Abstract
Acromegaly is a chronic disease characterized by the presence of a pituitary growth hormone (GH)-producing tumour, excessive secretion of growth hormone, raised levels of insulin-like growth factor I (IGF-I) and characteristic clinical presentation of acral enlargement. Over the past two decades, major advances have occurred in the understanding of some aspects of acromegaly--such as the biology of pituitary tumours, the physiology, molecular mechanisms of GH secretion and IGF-I generation, and the pathogenesis of comorbidities. Moreover, new approaches to diagnosis and surveillance (both in terms of screening and follow-up) of acromegaly have led to increases in the number of patients diagnosed with active disease, many of whom would previously have been missed. The development of sensitive assays for detecting plasma GH and IGF-I levels, as well as the widespread use of MRI for visualization of small tumours, have been major contributing factors to these improvements. Treatment advances have resulted in improved cure rates and disease control through novel neurosurgical techniques and pharmacological approaches. This Review summarizes and discusses the changes in our understanding of the epidemiology, diagnosis, treatment, and follow-up of acromegaly and its comorbidities.
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Affiliation(s)
- Antônio Ribeiro-Oliveira
- Federal University of Minas Gerais, Department of Internal Medicine, Rua Alfredo Balena 110, Belo Horizonte, MG 30330-120, Brazil
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