porozendoОстеопороз и остеопатииOsteoporosis and Bone Diseases2072-26802311-0716Endocrinology Research Centre10.14341/osteo11353porozendo-11353Research ArticleНаучный обзорReviewРевматические проявления акромегалииRheumatic manifestations of acromegalyhttps://orcid.org/0000-0002-5290-156XПаневинТарас СергеевичPanevinTaras S.

MD

tarasel@list.ruhttps://orcid.org/0000-0001-7017-0898АлексееваЛюдмила ИвановнаAlekseevaLyudmila I.

д.м.н.

MD, PhD

dr.alekseeva@gmail.comhttps://orcid.org/0000-0002-5634-7877МельниченкоГалина АфанасьевнаMelnichenkoGalina A.

д.м.н., профессор, академик РАН

MD, PhD, Professor

teofrast2000@mail.ruФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»; ФГБУ «Национальный медицинский исследовательский центр эндокринологии»РоссияV.A. Nasonova Research Institute of Rheumatology; Endocrinology Research CentreRussian FederationФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»РоссияV.A. Nasonova Research Institute of RheumatologyRussian FederationФГБУ «Национальный медицинский исследовательский центр эндокринологии»РоссияEndocrinology Research CentreRussian Federation2019070220202221422Copyright © Паневин Т.С., Алексеева Л.И., Мельниченко Г.А., 20192019Паневин Т.С., Алексеева Л.И., Мельниченко Г.А.Panevin T.S., Alekseeva L.I., Melnichenko G.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.osteo-endojournals.ru/jour/article/view/11353

Акромегалия – это хроническое эндокринное заболевание, характеризующееся избыточной секрецией гормона роста (соматотропного гормона, СТГ), которая, в свою очередь, приводит к увеличению секреции инсулиноподобного фактора роста 1 (ИФР-1) в печени. Избыток СТГ и ИФР-1 приводит к клеточному и тканевому росту практически всех органов и систем, в том числе костно-суставного аппарата. Суставная боль при акромегалии является частым и ранним симптомом, в некоторых случаях суставные проявления могут быть одним из первых признаков, их интенсивность увеличивается с естественным течением заболевания при отсутствии лечения. В среднем признаки поражения суставов встречаются у 70% пациентов на момент постановки диагноза. Поражение опорно-двигательного аппарата может затрагивать как осевой скелет, так и периферические суставы. Помимо артропатии, пациенты с акромегалией (как активной, так и контролируемой) чаще подвержены переломам позвонков, хотя ранее считалось, что при данном заболевании имеет место низкий риск развития остеопороза. В данном обзоре рассмотрены особенности поражения осевого скелета, периферических суставов при избыточной продукции СТГ и ИФР-1, а также ассоциация аутоиммунных ревматических заболеваний и акромегалии.

Acromegaly is a chronic endocrine disease characterized by excessive secretion of growth hormone (GH), which, in turn, leads to increased insulin-like growth factor 1 (IGF-1) secretion by the liver. GH and IGF-1 excess leads to excessive cell and tissue growth, including the osteoarticular apparatus. Joint pain in acromegaly is a frequent and early symptom. In some cases, joint manifestations can be one of the first signs of acromegaly and their intensity increases with duration of the active disease. Estimated prevalence of joint damage signs is around 70% of patients at the time of diagnosis of acromegaly. Musculoskeletal system alterations can manifest either in axial skeleton and peripheral joints. Besides arthropathy, patients with acromegaly (both active and controlled) are more prone to vertebral fractures, although it was previously thought that acromegaly has a low risk of osteoporosis. In this article, we review features of damage to the axial skeleton, peripheral joints in the setting of excessive GH and IGF-1 production, as well as the association of autoimmune rheumatic diseases and acromegaly.

акромегалияартропатияинсулиноподобный фактор роста 1остеоартритсуставыостеопорозacromegalyarthropathyinsulin-like growth factor 1osteoarthritisjointsosteoporosisReferencesMelmed S. Acromegaly. N Engl J Med. 1990;322(14):966-977. doi: https://doi.org/10.1056/NEJM199004053221405Melmed S. Acromegaly. N Engl J Med. 1990;322(14):966-977. doi: https://doi.org/10.1056/NEJM199004053221405Biermasz NR, Pereira AM, Smit JW, et al. Morbidity after long-term remission for acromegaly: persisting joint-related complaints cause reduced quality of life. J Clin Endocrinol Metab. 2005;90(5):2731-2739. doi: https://doi.org/10.1210/jc.2004-2297Biermasz NR, Pereira AM, Smit JW, et al. Morbidity after long-term remission for acromegaly: persisting joint-related complaints cause reduced quality of life. J Clin Endocrinol Metab. 2005;90(5):2731-2739. doi: https://doi.org/10.1210/jc.2004-2297Ben-Shlomo A, Melmed S. Acromegaly. Endocrinol Metab Clin North Am. 2001;30(3):565-583. doi: https://doi.org/10.1016/s0889-8529(05)70202-4Ben-Shlomo A, Melmed S. Acromegaly. Endocrinol Metab Clin North Am. 2001;30(3):565-583. doi: https://doi.org/10.1016/s0889-8529(05)70202-4Detenbeck LC, Tressler HA, O’Duffy JD, Randall RV. Peripheral joint manifestations of acromegaly. Clin Orthop Relat Res. 1973;(91):119-127. doi: https://doi.org/10.1097/00003086-197303000-00017Detenbeck LC, Tressler HA, O’Duffy JD, Randall RV. Peripheral joint manifestations of acromegaly. Clin Orthop Relat Res. 1973;(91):119-127. doi: https://doi.org/10.1097/00003086-197303000-00017Killinger Z, Payer J, Lazurova I, et al. Arthropathy in acromegaly. Rheum Dis Clin North Am. 2010;36(4):713-720. doi: https://doi.org/10.1016/j.rdc.2010.09.004Killinger Z, Payer J, Lazurova I, et al. Arthropathy in acromegaly. Rheum Dis Clin North Am. 2010;36(4):713-720. doi: https://doi.org/10.1016/j.rdc.2010.09.004Wassenaar MJ, Biermasz NR, van Duinen N, et al. High prevalence of arthropathy, according to the definitions of radiological and clinical osteoarthritis, in patients with long-term cure of acromegaly: a case-control study. Eur J Endocrinol. 2009;160(3):357-365. doi: https://doi.org/10.1530/EJE-08-0845Wassenaar MJ, Biermasz NR, van Duinen N, et al. High prevalence of arthropathy, according to the definitions of radiological and clinical osteoarthritis, in patients with long-term cure of acromegaly: a case-control study. Eur J Endocrinol. 2009;160(3):357-365. doi: https://doi.org/10.1530/EJE-08-0845Barkan AL. Acromegalic arthropathy. Pituitary. 2001;4(4):263-264. doi: https://doi.org/10.1023/a:1020754615863Barkan AL. Acromegalic arthropathy. Pituitary. 2001;4(4):263-264. doi: https://doi.org/10.1023/a:1020754615863Scarpa R, De Brasi D, Pivonello R, et al. Acromegalic axial arthropathy: a clinical case-control study. J Clin Endocrinol Metab. 2004;89(2):598-603. doi: https://doi.org/10.1210/jc.2003-031283Scarpa R, De Brasi D, Pivonello R, et al. Acromegalic axial arthropathy: a clinical case-control study. J Clin Endocrinol Metab. 2004;89(2):598-603. doi: https://doi.org/10.1210/jc.2003-031283Wassenaar MJ, Biermasz NR, Pereira AM, et al. The exon-3 deleted growth hormone receptor polymorphism predisposes to long-term complications of acromegaly. J Clin Endocrinol Metab. 2009;94(12):4671-4678. doi: https://doi.org/10.1210/jc.2009-1172Wassenaar MJ, Biermasz NR, Pereira AM, et al. The exon-3 deleted growth hormone receptor polymorphism predisposes to long-term complications of acromegaly. J Clin Endocrinol Metab. 2009;94(12):4671-4678. doi: https://doi.org/10.1210/jc.2009-1172Fortier LA, Mohammed HO, Lust G, Nixon AJ. Insulin-like growth factor-I enhances cell-based repair of articular cartilage. J Bone Joint Surg Br. 2002;84(2):276-288. doi: https://doi.org/10.1302/0301-620x.84b2.11167Fortier LA, Mohammed HO, Lust G, Nixon AJ. Insulin-like growth factor-I enhances cell-based repair of articular cartilage. J Bone Joint Surg Br. 2002;84(2):276-288. doi: https://doi.org/10.1302/0301-620x.84b2.11167Miller RE, Grodzinsky AJ, Cummings K, et al. Intraarticular injection of heparin-binding insulin-like growth factor 1 sustains delivery of insulin-like growth factor 1 to cartilage through binding to chondroitin sulfate. Arthritis Rheum. 2010;62(12):3686-3694. doi: https://doi.org/10.1002/art.27709Miller RE, Grodzinsky AJ, Cummings K, et al. Intraarticular injection of heparin-binding insulin-like growth factor 1 sustains delivery of insulin-like growth factor 1 to cartilage through binding to chondroitin sulfate. Arthritis Rheum. 2010;62(12):3686-3694. doi: https://doi.org/10.1002/art.27709Barkan A. Acromegalic arthropathy and sleep apnea. J Endocrinol. 1997;155 Suppl 1:S41–S44.Barkan A. Acromegalic arthropathy and sleep apnea. J Endocrinol. 1997;155 Suppl 1:S41–S44.Chipman JJ, Attanasio AF, Birkett MA, et al. The safety profile of GH replacement therapy in adults. Clin Endocrinol (Oxf). 1997;46(4):473-481. doi: https://doi.org/10.1046/j.1365-2265.1997.1660984.xChipman JJ, Attanasio AF, Birkett MA, et al. The safety profile of GH replacement therapy in adults. Clin Endocrinol (Oxf). 1997;46(4):473-481. doi: https://doi.org/10.1046/j.1365-2265.1997.1660984.xColao A, Cannavo S, Marzullo P, et al. Twelve months of treatment with octreotide-LAR reduces joint thickness in acromegaly. Eur J Endocrinol. 2003;148(1):31-38. doi: https://doi.org/10.1530/eje.0.1480031Colao A, Cannavo S, Marzullo P, et al. Twelve months of treatment with octreotide-LAR reduces joint thickness in acromegaly. Eur J Endocrinol. 2003;148(1):31-38. doi: https://doi.org/10.1530/eje.0.1480031Wassenaar MJ, Biermasz NR, Bijsterbosch J, et al. Arthropathy in long-term cured acromegaly is characterised by osteophytes without joint space narrowing: a comparison with generalised osteoarthritis. Ann Rheum Dis. 2011;70(2):320-325. doi: https://doi.org/10.1136/ard.2010.131698Wassenaar MJ, Biermasz NR, Bijsterbosch J, et al. Arthropathy in long-term cured acromegaly is characterised by osteophytes without joint space narrowing: a comparison with generalised osteoarthritis. Ann Rheum Dis. 2011;70(2):320-325. doi: https://doi.org/10.1136/ard.2010.131698Claessen KM, Kroon HM, Pereira AM, et al. Progression of vertebral fractures despite long-term biochemical control of acromegaly: a prospective follow-up study. J Clin Endocrinol Metab. 2013;98(12):4808-4815. doi: https://doi.org/10.1210/jc.2013-2695Claessen KM, Kroon HM, Pereira AM, et al. Progression of vertebral fractures despite long-term biochemical control of acromegaly: a prospective follow-up study. J Clin Endocrinol Metab. 2013;98(12):4808-4815. doi: https://doi.org/10.1210/jc.2013-2695Kropf LL, Madeira M, Vieira Neto L, et al. Functional evaluation of the joints in acromegalic patients and associated factors. Clin Rheumatol. 2013;32(7):991-998. doi: https://doi.org/10.1007/s10067-013-2219-1Kropf LL, Madeira M, Vieira Neto L, et al. Functional evaluation of the joints in acromegalic patients and associated factors. Clin Rheumatol. 2013;32(7):991-998. doi: https://doi.org/10.1007/s10067-013-2219-1Мокрышева Н.Г., Еремкина А.К., Мирная С.С., и др. Патологические изменения в суставах и мышцах при первичном гиперпаратиреозе. // Остеопороз и остеопатии. — 2018. — Т. 21. — №4. — С. 10-18. [Mokrysheva NG, Eremkina AK, Mirnaya SS, et al. Joint and muscle involvement in primary hyperparathyroidism. Osteoporosis and bone diseases. 2018;21(4):10-18. (In Russ.)] doi: https://doi.org/10.14341/osteo9783Мокрышева Н.Г., Еремкина А.К., Мирная С.С., и др. Патологические изменения в суставах и мышцах при первичном гиперпаратиреозе. // Остеопороз и остеопатии. — 2018. — Т. 21. — №4. — С. 10-18. [Mokrysheva NG, Eremkina AK, Mirnaya SS, et al. Joint and muscle involvement in primary hyperparathyroidism. Osteoporosis and bone diseases. 2018;21(4):10-18. (In Russ.)] doi: https://doi.org/10.14341/osteo9783Claessen K, Canete AN, de Bruin PW, et al. Acromegalic arthropathy in various stages of the disease: an MRI study. Eur J Endocrinol. 2017;176(6):779-790. doi: https://doi.org/10.1530/EJE-16-1073Claessen K, Canete AN, de Bruin PW, et al. Acromegalic arthropathy in various stages of the disease: an MRI study. Eur J Endocrinol. 2017;176(6):779-790. doi: https://doi.org/10.1530/EJE-16-1073Bluestone R, Bywaters EG, Hartog M, et al. Acromegalic arthropathy. Ann Rheum Dis. 1971;30(3):243-258. doi: https://doi.org/10.1136/ard.30.3.243Bluestone R, Bywaters EG, Hartog M, et al. Acromegalic arthropathy. Ann Rheum Dis. 1971;30(3):243-258. doi: https://doi.org/10.1136/ard.30.3.243Nezu M, Kudo M, Morimoto R, et al. Effects of surgical treatment for acromegaly on knee MRI structural features. Endocr J. 2018;65(10):991-999. doi: https://doi.org/10.1507/endocrj.EJ18-0108Nezu M, Kudo M, Morimoto R, et al. Effects of surgical treatment for acromegaly on knee MRI structural features. Endocr J. 2018;65(10):991-999. doi: https://doi.org/10.1507/endocrj.EJ18-0108Wassenaar MJ, Biermasz NR, Kloppenburg M, et al. Clinical osteoarthritis predicts physical and psychological QoL in acromegaly patients. Growth Horm IGF Res. 2010;20(3):226-233. doi: https://doi.org/10.1016/j.ghir.2010.02.003Wassenaar MJ, Biermasz NR, Kloppenburg M, et al. Clinical osteoarthritis predicts physical and psychological QoL in acromegaly patients. Growth Horm IGF Res. 2010;20(3):226-233. doi: https://doi.org/10.1016/j.ghir.2010.02.003Claessen KM, Kloppenburg M, Kroon HM, et al. Two phenotypes of arthropathy in long-term controlled acromegaly? A comparison between patients with and without joint space narrowing (JSN). Growth Horm IGF Res. 2013;23(5):159-164. doi: https://doi.org/10.1016/j.ghir.2013.05.003Claessen KM, Kloppenburg M, Kroon HM, et al. Two phenotypes of arthropathy in long-term controlled acromegaly? A comparison between patients with and without joint space narrowing (JSN). Growth Horm IGF Res. 2013;23(5):159-164. doi: https://doi.org/10.1016/j.ghir.2013.05.003Felson DT, Lawrence RC, Dieppe PA, et al. Osteoarthritis: new insights. Part 1: the disease and its risk factors. Ann Intern Med. 2000;133(8):635-646. doi: https://doi.org/10.7326/0003-4819-133-8-200010170-00016Felson DT, Lawrence RC, Dieppe PA, et al. Osteoarthritis: new insights. Part 1: the disease and its risk factors. Ann Intern Med. 2000;133(8):635-646. doi: https://doi.org/10.7326/0003-4819-133-8-200010170-00016Biermasz NR, Pereira AM, Frolich M, et al. Octreotide represses secretory-burst mass and nonpulsatile secretion but does not restore event frequency or orderly GH secretion in acromegaly. Am J Physiol Endocrinol Metab. 2004;286(1):E25-30. doi: https://doi.org/10.1152/ajpendo.00230.2003Biermasz NR, Pereira AM, Frolich M, et al. Octreotide represses secretory-burst mass and nonpulsatile secretion but does not restore event frequency or orderly GH secretion in acromegaly. Am J Physiol Endocrinol Metab. 2004;286(1):E25-30. doi: https://doi.org/10.1152/ajpendo.00230.2003van Thiel SW, Bax JJ, Biermasz NR, et al. Persistent diastolic dysfunction despite successful long-term octreotide treatment in acromegaly. Eur J Endocrinol. 2005;153(2):231-238. doi: https://doi.org/10.1530/eje.1.01955van Thiel SW, Bax JJ, Biermasz NR, et al. Persistent diastolic dysfunction despite successful long-term octreotide treatment in acromegaly. Eur J Endocrinol. 2005;153(2):231-238. doi: https://doi.org/10.1530/eje.1.01955Weiss RE, Reddi AH, Nimni ME. Somatostatin can locally inhibit proliferation and differentiation of cartilage and bone precursor cells. Calcif Tissue Int. 1981;33(4):425-430. doi: https://doi.org/10.1007/bf02409466Weiss RE, Reddi AH, Nimni ME. Somatostatin can locally inhibit proliferation and differentiation of cartilage and bone precursor cells. Calcif Tissue Int. 1981;33(4):425-430. doi: https://doi.org/10.1007/bf02409466Zapf J, Gosteli-Peter M, Weckbecker G, et al. The somatostatin analog octreotide inhibits GH-stimulated, but not IGF-I-stimulated, bone growth in hypophysectomized rats. Endocrinology. 2002;143(8):2944-2952. doi: https://doi.org/10.1210/endo.143.8.8970Zapf J, Gosteli-Peter M, Weckbecker G, et al. The somatostatin analog octreotide inhibits GH-stimulated, but not IGF-I-stimulated, bone growth in hypophysectomized rats. Endocrinology. 2002;143(8):2944-2952. doi: https://doi.org/10.1210/endo.143.8.8970Sievers C, Brubach K, Saller B, et al. Change of symptoms and perceived health in acromegalic patients on pegvisomant therapy: a retrospective cohort study within the German Pegvisomant Observational Study (GPOS). Clin Endocrinol (Oxf). 2010;73(1):89-94. doi: https://doi.org/10.1111/j.1365-2265.2009.03773.xSievers C, Brubach K, Saller B, et al. Change of symptoms and perceived health in acromegalic patients on pegvisomant therapy: a retrospective cohort study within the German Pegvisomant Observational Study (GPOS). Clin Endocrinol (Oxf). 2010;73(1):89-94. doi: https://doi.org/10.1111/j.1365-2265.2009.03773.xNeggers SJ, van Aken MO, de Herder WW, et al. Quality of life in acromegalic patients during long-term somatostatin analog treatment with and without pegvisomant. J Clin Endocrinol Metab. 2008;93(10):3853-3859. doi: https://doi.org/10.1210/jc.2008-0669Neggers SJ, van Aken MO, de Herder WW, et al. Quality of life in acromegalic patients during long-term somatostatin analog treatment with and without pegvisomant. J Clin Endocrinol Metab. 2008;93(10):3853-3859. doi: https://doi.org/10.1210/jc.2008-0669Colao A, Marzullo P, Vallone G, et al. Reversibility of joint thickening in acromegalic patients: an ultrasonography study. J Clin Endocrinol Metab. 1998;83(6):2121-2125. doi: https://doi.org/10.1210/jcem.83.6.4865Colao A, Marzullo P, Vallone G, et al. Reversibility of joint thickening in acromegalic patients: an ultrasonography study. J Clin Endocrinol Metab. 1998;83(6):2121-2125. doi: https://doi.org/10.1210/jcem.83.6.4865Colao A, Marzullo P, Vallone G, et al. Ultrasonographic evidence of joint thickening reversibility in acromegalic patients treated with lanreotide for 12 months. Clin Endocrinol (Oxf). 1999;51(5):611-618. doi: https://doi.org/10.1046/j.1365-2265.1999.00851.xColao A, Marzullo P, Vallone G, et al. Ultrasonographic evidence of joint thickening reversibility in acromegalic patients treated with lanreotide for 12 months. Clin Endocrinol (Oxf). 1999;51(5):611-618. doi: https://doi.org/10.1046/j.1365-2265.1999.00851.xClaessen KM, Ramautar SR, Pereira AM, et al. Progression of acromegalic arthropathy despite long-term biochemical control: a prospective, radiological study. Eur J Endocrinol. 2012;167(2):235-244. doi: https://doi.org/10.1530/EJE-12-0147Claessen KM, Ramautar SR, Pereira AM, et al. Progression of acromegalic arthropathy despite long-term biochemical control: a prospective, radiological study. Eur J Endocrinol. 2012;167(2):235-244. doi: https://doi.org/10.1530/EJE-12-0147Neggers SJ, van Aken MO, de Herder WW, et al. Quality of life in acromegalic patients during long-term somatostatin analog treatment with and without pegvisomant. J Clin Endocrinol Metab. 2008;93(10):3853-3859. doi: https://doi.org/10.1210/jc.2008-0669Neggers SJ, van Aken MO, de Herder WW, et al. Quality of life in acromegalic patients during long-term somatostatin analog treatment with and without pegvisomant. J Clin Endocrinol Metab. 2008;93(10):3853-3859. doi: https://doi.org/10.1210/jc.2008-0669Podgorski M, Robinson B, Weissberger A, et al. Articular manifestations of acromegaly. Aust N Z J Med. 1988;18(1):28-35. doi: https://doi.org/10.1111/j.1445-5994.1988.tb02236.xPodgorski M, Robinson B, Weissberger A, et al. Articular manifestations of acromegaly. Aust N Z J Med. 1988;18(1):28-35. doi: https://doi.org/10.1111/j.1445-5994.1988.tb02236.xColao A, Ferone D, Marzullo P, Lombardi G. Systemic complications of acromegaly: epidemiology, pathogenesis, and management. Endocr Rev. 2004;25(1):102-152. doi: https://doi.org/10.1210/er.2002-0022Colao A, Ferone D, Marzullo P, Lombardi G. Systemic complications of acromegaly: epidemiology, pathogenesis, and management. Endocr Rev. 2004;25(1):102-152. doi: https://doi.org/10.1210/er.2002-0022Colao A, Pivonello R, Scarpa R, et al. The acromegalic arthropathy. J Endocrinol Invest. 2005;28(8 Suppl):24-31.Colao A, Pivonello R, Scarpa R, et al. The acromegalic arthropathy. J Endocrinol Invest. 2005;28(8 Suppl):24-31.Lacks S, Jacobs RP. Acromegalic arthropathy: a reversible rheumatic disease. J Rheumatol. 1986;13(3):634-636.Lacks S, Jacobs RP. Acromegalic arthropathy: a reversible rheumatic disease. J Rheumatol. 1986;13(3):634-636.Mazziotti G, Bianchi A, Bonadonna S, et al. Prevalence of vertebral fractures in men with acromegaly. J Clin Endocrinol Metab. 2008;93(12):4649-4655. doi: https://doi.org/10.1210/jc.2008-0791Mazziotti G, Bianchi A, Bonadonna S, et al. Prevalence of vertebral fractures in men with acromegaly. J Clin Endocrinol Metab. 2008;93(12):4649-4655. doi: https://doi.org/10.1210/jc.2008-0791Romijn JA. Acromegalic arthropathy: current perspectives. Endocrine. 2013;43(2):245-246. doi: https://doi.org/10.1007/s12020-012-9781-1Romijn JA. Acromegalic arthropathy: current perspectives. Endocrine. 2013;43(2):245-246. doi: https://doi.org/10.1007/s12020-012-9781-1Mazziotti G, Bianchi A, Porcelli T, et al. Vertebral Fractures in Patients With Acromegaly: A 3-Year Prospective Study. J Clin Endocrinol Metab. 2013;98(8):3402-3410. doi: https://doi.org/10.1210/jc.2013-1460Mazziotti G, Bianchi A, Porcelli T, et al. Vertebral Fractures in Patients With Acromegaly: A 3-Year Prospective Study. J Clin Endocrinol Metab. 2013;98(8):3402-3410. doi: https://doi.org/10.1210/jc.2013-1460Padova G, Borzi G, Incorvaia L, et al. Prevalence of osteoporosis and vertebral fractures in acromegalic patients. Clin Cases Miner Bone Metab. 2011;8(3):37-43.Padova G, Borzi G, Incorvaia L, et al. Prevalence of osteoporosis and vertebral fractures in acromegalic patients. Clin Cases Miner Bone Metab. 2011;8(3):37-43.Mazziotti G, Gola M, Bianchi A, et al. Influence of diabetes mellitus on vertebral fractures in men with acromegaly. Endocrine. 2011;40(1):102-108. doi: https://doi.org/10.1007/s12020-011-9486-xMazziotti G, Gola M, Bianchi A, et al. Influence of diabetes mellitus on vertebral fractures in men with acromegaly. Endocrine. 2011;40(1):102-108. doi: https://doi.org/10.1007/s12020-011-9486-xMadeira M, Neto LV, de Paula Paranhos Neto F, et al. Acromegaly Has a Negative Influence on Trabecular Bone, But Not on Cortical Bone, as Assessed by High-Resolution Peripheral Quantitative Computed Tomography. J Clin Endocrinol Metab. 2013;98(4):1734-1741. doi: https://doi.org/10.1210/jc.2012-4073Madeira M, Neto LV, de Paula Paranhos Neto F, et al. Acromegaly Has a Negative Influence on Trabecular Bone, But Not on Cortical Bone, as Assessed by High-Resolution Peripheral Quantitative Computed Tomography. J Clin Endocrinol Metab. 2013;98(4):1734-1741. doi: https://doi.org/10.1210/jc.2012-4073Wassenaar MJE, Biermasz NR, Hamdy NAT, et al. High prevalence of vertebral fractures despite normal bone mineral density in patients with long-term controlled acromegaly. Eur J Endocrinol. 2011;164(4):475-483. doi: https://doi.org/10.1530/eje-10-1005Wassenaar MJE, Biermasz NR, Hamdy NAT, et al. High prevalence of vertebral fractures despite normal bone mineral density in patients with long-term controlled acromegaly. Eur J Endocrinol. 2011;164(4):475-483. doi: https://doi.org/10.1530/eje-10-1005Lesse GP, Fraser WD, Farquharson R, et al. Gonadal status is an important determinant of bone density in acromegaly. Clin Endocrinol (Oxf). 1998;48(1):59-65. doi: https://doi.org/10.1046/j.1365-2265.1998.00349.xLesse GP, Fraser WD, Farquharson R, et al. Gonadal status is an important determinant of bone density in acromegaly. Clin Endocrinol (Oxf). 1998;48(1):59-65. doi: https://doi.org/10.1046/j.1365-2265.1998.00349.xMazziotti G, Bianchi A, Bonadonna S, et al. Increased prevalence of radiological spinal deformities in adult patients with GH deficiency: influence of GH replacement therapy. J Bone Miner Res. 2006;21(4):520-528. doi: https://doi.org/10.1359/jbmr.060112Mazziotti G, Bianchi A, Bonadonna S, et al. Increased prevalence of radiological spinal deformities in adult patients with GH deficiency: influence of GH replacement therapy. J Bone Miner Res. 2006;21(4):520-528. doi: https://doi.org/10.1359/jbmr.060112Genant HK, Wu CY, van Kuijk C, Nevitt MC. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res. 1993;8(9):1137-1148. doi: https://doi.org/10.1002/jbmr.5650080915Genant HK, Wu CY, van Kuijk C, Nevitt MC. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res. 1993;8(9):1137-1148. doi: https://doi.org/10.1002/jbmr.5650080915Oruk G, Tarhan F, Argin M, Ozmen M. Is every joint symptom related to acromegaly? Endocrine. 2013;43(2):404-411. doi: https://doi.org/10.1007/s12020-012-9770-4Oruk G, Tarhan F, Argin M, Ozmen M. Is every joint symptom related to acromegaly? Endocrine. 2013;43(2):404-411. doi: https://doi.org/10.1007/s12020-012-9770-4Ozcakar L, Akinci A, Bal S. A challenging case of rheumatoid arthritis in an acromegalic patient. Rheumatol Int. 2003;23(3):146-148. doi: https://doi.org/10.1007/s00296-002-0280-1Ozcakar L, Akinci A, Bal S. A challenging case of rheumatoid arthritis in an acromegalic patient. Rheumatol Int. 2003;23(3):146-148. doi: https://doi.org/10.1007/s00296-002-0280-1Aydin Y, Coskun H, Kir S, et al. Rheumatoid arthritis masquerading as acromegaly recurrence: report of two cases. Rheumatol Int. 2012;32(9):2913-2915. doi: https://doi.org/10.1007/s00296-010-1490-6Aydin Y, Coskun H, Kir S, et al. Rheumatoid arthritis masquerading as acromegaly recurrence: report of two cases. Rheumatol Int. 2012;32(9):2913-2915. doi: https://doi.org/10.1007/s00296-010-1490-6Read RC, Watt I, Dieppe PA. Rheumatoid arthritis and acromegaly--effect of growth factors on RA? Br J Rheumatol. 1988;27(3):242-243. doi: https://doi.org/10.1093/rheumatology/27.3.242Read RC, Watt I, Dieppe PA. Rheumatoid arthritis and acromegaly--effect of growth factors on RA? Br J Rheumatol. 1988;27(3):242-243. doi: https://doi.org/10.1093/rheumatology/27.3.242Miyoshi T, Otsuka F, Kawabata T, et al. Manifestation of rheumatoid arthritis after transsphenoidal surgery in a patient with acromegaly. Endocr J. 2006;53(5):621-625. doi: https://doi.org/10.1507/endocrj.k06-043Miyoshi T, Otsuka F, Kawabata T, et al. Manifestation of rheumatoid arthritis after transsphenoidal surgery in a patient with acromegaly. Endocr J. 2006;53(5):621-625. doi: https://doi.org/10.1507/endocrj.k06-043Nachtigall LB. Acromegaly diagnosed in a young woman presenting with headache and arthritis. Nat Clin Pract Endocrinol Metab. 2006;2(10):582-587. doi: https://doi.org/10.1038/ncpendmet0301Nachtigall LB. Acromegaly diagnosed in a young woman presenting with headache and arthritis. Nat Clin Pract Endocrinol Metab. 2006;2(10):582-587. doi: https://doi.org/10.1038/ncpendmet0301Chanson P, Salenave S, Kamenicky P, et al. Pituitary tumours: acromegaly. Best Pract Res Clin Endocrinol Metab. 2009;23(5):555-574. doi: https://doi.org/10.1016/j.beem.2009.05.010Chanson P, Salenave S, Kamenicky P, et al. Pituitary tumours: acromegaly. Best Pract Res Clin Endocrinol Metab. 2009;23(5):555-574. doi: https://doi.org/10.1016/j.beem.2009.05.010Паневин Т.С., Алекперов Р.Т., Мельниченко Г.А. Синдром Рейно в практике эндокринолога. // Ожирение и метаболизм. — 2019. — Т. 16. — №4. (в печати) [Panevin TS, Alekperov RT, Melnichenko GA. Raynaud’s phenomenon in the endocrinologist’s practice. Obesity and metabolism. 2019;16(4) (in press). (In Russ.)] doi: https://doi.org/https://doi.org/10.14341/omet10245Паневин Т.С., Алекперов Р.Т., Мельниченко Г.А. Синдром Рейно в практике эндокринолога. // Ожирение и метаболизм. — 2019. — Т. 16. — №4. (в печати) [Panevin TS, Alekperov RT, Melnichenko GA. Raynaud’s phenomenon in the endocrinologist’s practice. Obesity and metabolism. 2019;16(4) (in press). (In Russ.)] doi: https://doi.org/https://doi.org/10.14341/omet10245Schiavon F, Maffei P, Martini C, et al. Morphologic study of microcirculation in acromegaly by capillaroscopy. J Clin Endocrinol Metab. 1999;84(9):3151-3155. doi: https://doi.org/10.1210/jcem.84.9.5952Schiavon F, Maffei P, Martini C, et al. Morphologic study of microcirculation in acromegaly by capillaroscopy. J Clin Endocrinol Metab. 1999;84(9):3151-3155. doi: https://doi.org/10.1210/jcem.84.9.5952Miller A, Doll H, David J, Wass J. Impact of musculoskeletal disease on quality of life in long-standing acromegaly. Eur J Endocrinol. 2008;158(5):587-593. doi: https://doi.org/10.1530/EJE-07-0838Miller A, Doll H, David J, Wass J. Impact of musculoskeletal disease on quality of life in long-standing acromegaly. Eur J Endocrinol. 2008;158(5):587-593. doi: https://doi.org/10.1530/EJE-07-0838Kameyama S, Tanaka R, Hasegawa A, et al. Subclinical carpal tunnel syndrome in acromegaly. Neurol Med Chir (Tokyo). 1993;33(8):547-551. doi: https://doi.org/10.2176/nmc.33.547Kameyama S, Tanaka R, Hasegawa A, et al. Subclinical carpal tunnel syndrome in acromegaly. Neurol Med Chir (Tokyo). 1993;33(8):547-551. doi: https://doi.org/10.2176/nmc.33.547Tani Y, Tanaka N, Isoya E. Locking of metacarpophalangeal jointsin a patient with acromegaly. Skeletal Radiol.1999;28(11):655-657. doi: https://doi.org/10.1007/s002560050569Tani Y, Tanaka N, Isoya E. Locking of metacarpophalangeal jointsin a patient with acromegaly. Skeletal Radiol.1999;28(11):655-657. doi: https://doi.org/10.1007/s002560050569

The authors declare that there are no conflicts of interest present.