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Marques P, Sapinho I, Korbonits M. Pseudoacromegaly-A challenging entity in the endocrine clinic: A systematic review. Clin Endocrinol (Oxf) 2024; 100:542-557. [PMID: 38549284 DOI: 10.1111/cen.15053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 05/08/2024]
Abstract
OBJECTIVE Pseudoacromegaly encompasses conditions with features of acromegaly/gigantism, but no growth hormone (GH) or insulin-like growth factor-1 (IGF-1) excess. We aimed to review published pseudoacromegaly cases evaluated due to clinical suspicion of acromegaly. DESIGN/PATIENTS PubMed/Medline search was conducted to identify reported pseudoacromegaly cases, which were systematically reviewed to ensure they met eligibility criteria: (1) presentation suggestive of acromegaly; (2) acromegaly excluded based on normal GH, IGF-1 and/or GH suppression on oral glucose tolerance test (OGTT-GH); (3) diagnosis of the pseudoacromegaly condition was established. Data were retrieved from each case and analysed collectively. RESULTS Of 76 cases, 47 were males, mean ages at presentation and at first acromegaloid symptoms were 28 ± 16 and 17 ± 10 years, respectively. Most common conditions were pachydermoperiostosis (47%) and insulin-mediated pseudoacromegaly (IMP) (24%). Acromegaloid facies (75%) and acral enlargement (80%) were the most common features. Measurement of random GH was reported in 65%, IGF-1 in 79%, OGTT-GH in 51%. GH excess was more frequently excluded based on two tests (53%). Magnetic resonance imaging (MRI) was performed in 30 patients, with pituitary adenoma or hyperplasia being reported in eight and three patients, respectively. Investigations differed between cases managed by endocrine and non-endocrine specialists, the former requesting more often IGF-1, OGTT-GH and pituitary MRI. CONCLUSIONS Pseudoacromegaly is a challenging entity that may be encountered by endocrinologists. Pachydermoperiostosis and IMP are the conditions most often mimicking acromegaly. Adequate assessment of GH/IGF-1 is crucial to exclude acromegaly, which may be better performed by endocrinologists. Pituitary incidentalomas are common and require careful judgement to prevent unnecessary pituitary surgery.
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Affiliation(s)
- Pedro Marques
- Pituitary Tumor Unit, Endocrinology Department, Hospital CUF Descobertas, Lisbon, Portugal
- Faculdade de Medicina, Universidade Católica Portuguesa, Lisbon, Portugal
| | - Inês Sapinho
- Pituitary Tumor Unit, Endocrinology Department, Hospital CUF Descobertas, Lisbon, Portugal
| | - Márta Korbonits
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Marques P, Korbonits M. Approach to the Patient With Pseudoacromegaly. J Clin Endocrinol Metab 2022; 107:1767-1788. [PMID: 34792134 DOI: 10.1210/clinem/dgab789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Indexed: 11/19/2022]
Abstract
Pseudoacromegaly encompasses a heterogeneous group of conditions in which patients have clinical features of acromegaly or gigantism, but no excess of GH or IGF-1. Acromegaloid physical features or accelerated growth in a patient may prompt referral to endocrinologists. Because pseudoacromegaly conditions are rare and heterogeneous, often with overlapping clinical features, the underlying diagnosis may be challenging to establish. As many of these have a genetic origin, such as pachydermoperiostosis, Sotos syndrome, Weaver syndrome, or Cantú syndrome, collaboration is key with clinical geneticists in the diagnosis of these patients. Although rare, awareness of these uncommon conditions and their characteristic features will help their timely recognition.
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Affiliation(s)
- Pedro Marques
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, EC1M 6BQ London, UK
- Endocrinology Department, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal
| | - Márta Korbonits
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, EC1M 6BQ London, UK
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Shakya P, Pokhrel KN, Mlunde LB, Tan S, Ota E, Niizeki H. Effectiveness of non-steroidal anti-inflammatory drugs among patients with primary hypertrophic osteoarthropathy: A systematic review. J Dermatol Sci 2017; 90:21-26. [PMID: 29305259 DOI: 10.1016/j.jdermsci.2017.12.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 12/05/2017] [Accepted: 12/20/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Primary hypertrophic osteoarthropathy (PHO), also known as pachydermoperiostosis is a rare genetic disease which predominantly affects skin, bone and soft connective tissue. It is characterized by the triad of pachydermia, digital clubbing and periostosis of long bones. Arthralgia or arthritis is also present in most of the cases. Genetic studies have identified the impaired PGE2 metabolism as a culprit for hypertrophic osteoarthropathy in PHO cases. We conducted a systematic review to examine the effectiveness of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), a PGE2 synthesis blocker to reduce the symptoms among PHO patients. METHODS We searched the evidence in five databases; Cochrane Library, CINAHL, EMBASE, MEDLINE, and PubMed. We reported the evidence using narrative synthesis. RESULTS Out of 238 identified studies, we selected 26 for the synthesis. All were case reports which included a total of 54 patients. Among them, 39 patients were treated with at least one type of NSAIDs. Around 70% of the patients treated with NSAIDs had clinical improvement for their symptoms, mostly arthritis or arthralgia symptoms. CONCLUSION NSAIDs were effective in improving arthralgia or arthritis symptoms in majority of the PHO patients. Therefore, we recommend the use of NSAIDs in PHO patients to treat arthralgia or arthritis.
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Affiliation(s)
- Prakash Shakya
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Japan
| | - Khem N Pokhrel
- Health Research and Social Development Forum (HERD), P.O. Box 24133, Thapathali, Kathmandu, Nepal
| | - Linda B Mlunde
- Management and Development for Health, P.O. Box 79810, Dar es Salaam, Tanzania
| | - Suyun Tan
- Waseda University Bioscience Research Institute in Singapore, 11 Biopolis Way, #05-02 Helios, Singapore 138667, Singapore
| | - Erika Ota
- Department of Global Health Nursing, St. Luke's International University Graduate School of Nursing Science, Tokyo, Japan.
| | - Hironori Niizeki
- Division of Dermatology, National Center for Child Health and Development, Tokyo, Japan
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Abdullah NRA, Jason WLC, Nasruddin AB. Pachydermoperiostosis: a rare mimicker of acromegaly. Endocrinol Diabetes Metab Case Rep 2017; 2017:EDM170029. [PMID: 28567291 PMCID: PMC5445428 DOI: 10.1530/edm-17-0029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 04/11/2017] [Indexed: 11/23/2022] Open
Abstract
Pachydermoperiostosis is a very rare osteoarthrodermopathic disorder whose clinical and radiographic presentations may mimic those of acromegaly. In the evaluation of patients with acromegaloid appearances, pachydermoperiostosis should be considered as a differential diagnosis. In this article, we report a 17-year-old boy who presented with 2-year history of acral enlargement and facial appearance changes associated with joint pain and excessive sweating. He had been investigated extensively for acromegaly, and the final diagnosis was pachydermoperiostosis.
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Affiliation(s)
| | - Wong Lok Chin Jason
- Department of Medicine, National University of Malaysia Medical Centre, Kuala LumpurMalaysia
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[Primary hypertrophic osteoarthropathy (pachydermoperiostosis). Report of two familial cases and literature review]. ACTA ACUST UNITED AC 2009; 5:259-63. [PMID: 21794626 DOI: 10.1016/j.reuma.2009.01.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2008] [Revised: 01/11/2009] [Accepted: 01/15/2009] [Indexed: 11/22/2022]
Abstract
The primary hypertrophic osteoarthropathy (pachydermoperiostosis) is a hereditary disease characterized by skin thickening (pachydermia), finger clubbing, and proliferation of periosteum (periostitis) with subperiosteal new bone formation. We describe the cases of two brothers of 30 and 24 years, who consulted due to bone pain, arthralgia and oligoarthritis. Pachydermia, hyperhidrosis, seborrhea, digital clubbing, periostosis and non-inflammatory effusions of the knees. The first had been diagnosed with juvenile idiopathic arthritis at age 15, while the youngest also presented with a thoracic scoliosis, hypertrophic gastritis, iron deficiency anemia and glucose intolerance by pancreatic endocrine dysfunction. In both patients, symptoms were controlled satisfactorily with etoricoxib (90mg/day) and risedronate (35mg/week).
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Okten A, Mungan I, Kalyoncu M, Orbak Z. Two cases with pachydermoperiostosis and discussion of tamoxifen citrate treatment for arthralgia. Clin Rheumatol 2007; 26:8-11. [PMID: 16738844 DOI: 10.1007/s10067-005-1161-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2005] [Revised: 10/12/2004] [Accepted: 10/12/2004] [Indexed: 10/24/2022]
Abstract
Idiopathic hypertrophic osteoarthropathy is a rare syndrome, characterized by clubbing, progressive enlargement of the joints, coarse facial features suggesting acromegaly, palmoplantar hyperhidrosis, fibrous covering at the ends of long bones (periostosis), and acro-osteolysis. It is a self-limiting condition but arthralgia may be as severe as limiting social life and activity, and it is the main complaint to be treated. We report on two siblings with pachydermoperiostosis (PDP), one of whom had arthralgia. Although several drugs have been used, we used tamoxifen for his arthralgia and his complaint disappeared. To the best of our knowledge, this is the second case treated by tamoxifen reported in the literature.
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Affiliation(s)
- Aysenur Okten
- Department of Pediatrics, School of Medicine, Karadeniz Technical University, Pediatri Anabilim Dali, 61080 Trabzon, Turkey
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Abstract
Pachydermoperiostosis (PDP) is a rare genodermatosis, characterized by pachydermia, digital clubbing, periostosis and an excess of affected males. Although an autosomal dominant model with incomplete penetrance and variable expression has been proved, both autosomal recessive and X-linked inheritance have been suggested. However, at present, genetic heterogeneity is not fully supported. The aim of this study is to review the clinical and pedigree data of 68 published PDP families, including 204 patients. This analysis has confirmed an autosomal dominant mutation in 37 families and suggested the existence of an autosomal recessive form in the remaining families. The two forms may differ in clinical severity, intrafamilial variability and prevalence of some features. Additionally, the marked skewed sex ratio could not be easily explained by an X-linked mutation, but alternative explanations (i.e. testosterone promoting proliferation) are discussed.
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Affiliation(s)
- M Castori
- IRCCS-CSS San Giovanni Rotondo and CSS-Mendel Institute, Rome, Italy
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Rezgui-Marhoul L, Douira-Khomsi W, Bouslama K, Karoui M, Ben Dridi M, Hendaoui L. Pachydermopériostose : à propos de deux cas. ACTA ACUST UNITED AC 2005; 86:340-3. [PMID: 15908876 DOI: 10.1016/s0221-0363(05)81365-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Pachydermoperiostosis or primary hypertrophic osteoarthropathy is a benign genetically determined disease, manifested by finger clubbing, hypertrophic skin changes and periosteal bone formation. It is rarely reported and was for a long time misdiagnosed and confused with secondary hypertrophic osteoarthropathy. We present the imaging features in two cases and review the literature.
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Affiliation(s)
- L Rezgui-Marhoul
- Service d'Imagerie Médicale, CHU Mongi Slim, 2046 Sidi Daud, la Marsa-Tunisie.
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Ka MM, Ka EF, Dia D, Sy MH, Diallo S, Mbengue M, Dia M, Diop TM. [An incomplete form of pachydermoperiostosis. Diagnosis of finger clubbing]. Rev Med Interne 2002; 23:728-32. [PMID: 12360756 DOI: 10.1016/s0248-8663(02)00649-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The finger clubbing is most of the time associated with cardiovascular and pulmonary diseases. Pachydermoperiostosis also known as osteodermopathic syndrome, an hereditary disorder, is a rare cause of finger clubbing which might be difficult to diagnose in an incomplete form. EXEGESIS We report a 36 years old black man presenting over many years polyarthralgias, broadening of fingers and clubbing of the fingers and toes extremities. This was mentioned on other family members. The physical examination was otherwise unremarkable. There were no skin thickening, no psoriasis-like and cardio-pulmonary disease features. These following exams were normal; Hemogram, fibrinogen, C reactive protein, rheumatoïd factor, serum calcium and phosphorus, thyroid hormones, growth hormone, chest X-ray, gastroduodenoscopy, electrocardiogram. The skeletal X-ray documented a widespread bone formation, a sacro-iliac osteosclerosis and interosseous ossifications betwen tibias and fibulas. CONCLUSION Pachydermoperiostosis diagnosis was set up on 3 out of the 4 Borochowitz criteria. The absence of pachyderma defines this incomplete form. The osteoarticular manifestations lead mainly to differential diagnosis with the secondary hypertrophic osteoarthropathy and chronic inflammatory rheumatisms. The underlying pathogenic mechanism of this disease remains still unclear.
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Affiliation(s)
- M M Ka
- Clinique médicale I, CHU A Le Dantec, avenue Pasteur, BP 6237, Dakar, Sénégal.
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