Is every joint symptom related to acromegaly?

By London Spine
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Is every joint symptom related to acromegaly?

Endocrine. 2013 Apr;43(2):404-11

Authors: Örük G, Tarhan F, Argın M, Özmen M

Abstract
Acromegaly is a chronic endocrinopathy characterized by the hypersecretion of growth hormone and insulin-like growth factor-1. Musculoskeletal pain is a frequent problem encountered in acromegaly and is associated with a reduction in the quality of life. In this study, the presence of inflammatory and degenerative rheumatologic diseases in acromegaly has been retrospectively evaluated. Forty patients with acromegaly who were in remission according to laboratory findings, but still having joint and back pain problems, were referred to rheumatology outpatient clinic and all the patients were examined by clinical, radiological, and laboratory data. Mean age was 47.1 years (22-75). When the radiological data were evaluated, erosions of the left sacroiliac joint were found by means of magnetic resonance imaging in 1 patient and degenerative joint changes were observed in 24 patients by X-ray imaging. However, there was no pathology in the radiological data of 15 patients. Laboratory data revealed antinuclear antibody positivity (3 nucleolar and 1 homogeneous) in 4 patients, rheumatoid factor positivity in 4, and cyclic citrullinated peptide positivity only in 1 patient. The diagnosis of an inflammatory rheumatologic disease, including rheumatoid arthritis, ankylosing spondylitis, or undifferentiated connective tissue disease was made in 3 patients. Besides, the diagnosis of diffuse idiopathic skeletal hyperostosis was also established in 6 patients. While degenerative joint diseases were frequently observed in our group similar to the literature, inflammatory rheumatologic diseases were also found in three patients. Distinguishing these two diseases is important because response to medical treatment is dramatically better in inflammatory diseases than in degenerative pathologies. A multidisciplinary approach is imperative for appropriate management of these patients.

PMID: 22907627 [PubMed – indexed for MEDLINE]

Spinal deformity index in patients with type 2 diabetes.

By London Spine
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Spinal deformity index in patients with type 2 diabetes.

Endocrine. 2013 Jun;43(3):651-8

Authors: Di Somma C, Rubino M, Faggiano A, Vuolo L, Contaldi P, Tafuri N, Tafuto N, Andretti M, Savastano S, Colao A

Abstract
The objective of this study is to investigate bone metabolism, density, and quality in patients with diabetes type 2 using DEXA and spinal deformity index (SDI), a surrogate index of bone quality. Fifty-six patients with type 2 diabetes were studied; exclusion criteria were diseases and medications that affect bone and mineral metabolism. Mean age was 65 ± 7 years. Mean diabetes duration was 10 ± 7 years and mean HbA1C was 6.6 ± 0.5 %. BMI was 30 ± 4. Fifty-six sex, age, and BMI matched served as controls. All subjects underwent a clinical and biochemical examination. Spinal and femoral neck BMD were measured by DEXA, and a spine radiography was performed to assess vertebral fractures and to calculate SDI. Mean serum 25-OH vitamin D levels were 19.6 ± 3.7 ng/ml in patients and 30 ± 14 ng/ml in controls (p < 0.01). PTH serum levels were 47.9 ± 40 pg/ml in patients versus 37 ± 5.3 pg/ml in controls (p < 0.01). At lumbar spine there was a significant difference between patients and controls only for T-score (p = <0.01), while at femoral neck there was a difference in BMD (p < 0.01) and in T-score (p < 0.01). Radiological vertebral fractures were found in 46 % of patients and 17 % of controls (p < 0.05). SDI was higher in patients than in controls (p < 0.05). The percentage of fractures with T-score BMD greater than -2.5 was 69 % in patients and 10 % in controls (p < 0.05). As a conclusion, BMD was similar in patients and in controls, while SDI value was higher in patients; therefore, SDI was more specific than BMD for the diagnosis of osteoporosis due to metabolic diseases.

PMID: 23229683 [PubMed – indexed for MEDLINE]

The calcium-phosphate balance, modulation of thyroid autoimmune processes and other adverse effects connected with thyroid arterial embolization.

By London Spine
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The calcium-phosphate balance, modulation of thyroid autoimmune processes and other adverse effects connected with thyroid arterial embolization.

Endocrine. 2013 Oct 22;

Authors: Kaminski G, Jaroszuk A, Zybek A, Brzozowski K, Piasecki P, Ziecina P, Ruchala M

Abstract
In search of new treatment options for thyroid diseases, when conventional procedures are ineffective, contraindicated or associated with serious side effects, safety of thyroid arteries embolization in the treatment of particular thyroid diseases was evaluated. The study included eight subjects with retrosternal toxic goiter, six patients affected by Graves’ disease, five cases of retrosternal non-toxic goiter, two subjects with post-amiodarone hyperthyroidism, and one patient with severe thyroid-related orbitopathy, who underwent selective embolization of thyroid arteries. The study assessed and compared calcium-phosphate balance, modulation of thyroid autoimmunity and the presence of different side effects in patients who underwent the procedure. In addition, the serum concentrations of thyroid hormones, anti-thyroid autoantibodies and thyroid volume have been measured. Five of all enrolled subjects (22.7 %) experienced transient, not clinically relevant hypocalcaemia with no need for calcium supplementation. There were no significant changes in serum calcium levels in patients after embolization of both inferior thyroid arteries. The transient side effects associated with the treatment were neck pain and a slight increase in body temperature. Noted high concentration of free thyroid hormones immediately after the procedure was not accompanied by worsening of symptoms or signs of thyrotoxicosis. In patients with Graves’ disease, a significant decrease in thyrotropin receptor antibodies level was observed. Thyroid arterial embolization does not disturb permanently calcium-phosphate balance, modulates positively thyroid autoimmune processes and is associated with no serious post-procedure side effects. Hence, it may be considered as a safe and effective treatment modality for selected thyroid disorders.

PMID: 24146411 [PubMed – as supplied by publisher]