Manifestation of rheumatoid arthritis after transsphenoidal surgery in a patient with acromegaly.
Acromegalic arthropathy is one of the most frequent manifestations occurring in acromegaly patients. In contrast, rheumatoid arthritis (RA) is a rare clinical complication in acromegaly patients. Here, we report a 70-year-old Japanese woman with acromegaly, who complained of bilateral finger stiffness and polyarthralgia two months after transsphenoidal surgery of a growth hormone (GH)-secreting pituitary adenoma. Postoperative levels of serum GH and insulin-like growth factor-1 (IGF-1) were markedly decreased without any secretory deficiency of other anterior pituitary hormones. Hand X-ray did not show typical RA changes; however, erosive changes in carpal bones were clearly detected by magnetic resonance imaging with gadolinium enhancement. Based on the levels of serological markers in the patient following surgery including C-reactive protein, rheumatoid factor and matrix metalloproteinase-3, anti-rheumatic therapy was subsequently commenced. Regardless of the levels of GH and IGF-1, acromegaly patients frequently complain about joint-related symptoms even after remission. Therefore, careful observation of bone erosive changes and immunological activity in acromegaly patients is required when joint-related symptoms persist.
Miyoshi
Tomoko
T
Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Japan.
Otsuka
Fumio
F
Kawabata
Tomoko
T
Inagaki
Kenichi
K
Mukai
Tomoyuki
T
Kawashima
Masanori
M
Ogura
Toshio
T
Yamamura
Masahiro
M
Sei
Tetsuro
T
Makino
Hirofumi
H
D000172:Acromegaly / Q000150:complications*; D000236:Adenoma / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology*; D001855:Bone Marrow Diseases / Q000150:complications / Q000000981:diagnostic imaging; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D013006:Growth Hormone / Q000097:blood; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D006225:Hand / Q000000981:diagnostic imaging; D006801:Humans; D011859:Radiography; D011877:Radionuclide Imaging; D013100:Sphenoid Bone / Q000601:surgery*; D013585:Synovitis / Q000150:complications / Q000000981:diagnostic imaging
D013006:Growth Hormone; D002097:C-Reactive Protein