Acromegaly as An Endocrine Form of Myopathy: Case Report and Review of Literature |
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| Affiliation: | 1. Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China;2. Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China;3. National Clinical Research Center for Skin and Immune Diseases, Beijing, China;4. Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany;1. Department of Neurosurgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan;2. Department of Neurosurgery, National Hospital Organization Disaster Medical Center, Tachikawa, Tokyo, Japan;1. Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3° piso, Centro, Caixa Postal 464, Pelotas, Rio Grande do Sul, 96020-220, Brazil;2. Nutrition Faculty, Federal University of Pelotas, Rua Gomes Carneiro, 1, Centro, Pelotas, RS, 96010-610, Brazil;3. Department of Physiology and Pharmacology, Biology Institute, Federal University of Pelotas, S/N, Campus, Capão do Leão, RS, 96160-000, Brazil;1. Chronic Diseases (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran;2. Chronic Diseases (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran;3. Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran;4. Department of Endocrinology, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran;1. Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York;2. Department of Ophthalmology, Mount Sinai Hospital, New York, New York;3. Department of Dermatology and Cutaneous Biology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania;4. PXE International, Washington, DC |
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| Abstract: | ObjectiveTo describe a case of muscle weakness in a patient with acromegaly and to review the pathophysiologic features of this disorder.MethodsWe present the clinical, laboratory, electromyographic, and muscle biopsy findings in our patient and review related reports in the literature.ResultsA 58-year-old woman with acromegaly presented with complaints of bilateral hip pain, weakness, and instability 8 months after transsphenoidal resection of a growth hormone (GH)-secreting pituitary macroadenoma. She had biochemically normal thyroid and adrenal function and no evidence of any neuropathy, inflammatory myopathy, or rheumatologic disorder to explain her symptoms. Investigations revealed increased levels of GH, insulin-like growth factor-I, serum creatine kinase (CK), and the MB fraction of CK, normal results of nerve conduction studies, and nonspecific findings on electromyography and muscle biopsy. A review of the literature revealed that although muscle weakness is a well-recognized feature of acromegaly, only a few cases similar to ours have been reported since acromegaly was first described in the late 1800s. Little is known about the natural history, best diagnostic approach, and optimal therapy for this debilitating complication.ConclusionMuscle weakness in acromegaly is common and may result from a combination of the direct effect of GH excess on muscle and other metabolic derangements (hypothyroidism, hypoadrenalism, or diabetes). Mechanical factors may also contribute, such as joint laxity in conjunction with hypermobility. Affected patients may benefit from a reduction in GH levels and physiotherapy for adaptive training. Persistently increased serum CK levels in a patient with diabetes, for whom no other cause is found, should prompt an investigation for acromegaly. More research into this aspect of acromegaly is needed for enhancement of our understanding of, and therapy for, this debilitating condition. (Endocr Pract. 2005;11:18-22) |
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