Severe osteoarthritis at unexpected age

INTRODUCTION: Acromegaly is a rare chronic endocrine disease caused by a growth hormone (GH) – producing adenoma, resulting in elevated GH and insulin-like growth factor-1 (IGF-1) concentrations. GH and IGF-1 are essential for normal growth, differentiation, and repair of cartilage and bone; however, excess GH and IGF-1, which are characteristic of acromegaly, lead to an arthropathy that resembles osteoarthritis. Patients with acromegaly, whether it's surgically treated or biochemically controlled, still have a high risk of developing arthropathy. CLINICAL CASE: A 49-year-old woman presents to the university hospital for a visit with a complaint of knee pain. Her medical history reveals that she received an acromegaly diagnosis in 2010 and had been treated with surgery. However, she was not remission after the surgery; the patient's IGF-1 level was 686 ng/ml (Normal range: 109–284) when she presented. Her medical history reveals that she has been taking analgesics for the last four years. She has received octreotide (once-monthly 10 mg) and cabergoline (once-weekly 1 mg). The last laboratory results showed that her IGF-1 level had decreased dramatically; to 125 ng/ml. Based on the complaint of knee pain, imaging studies, including an X-ray, showed severe osteoarthritis. CONCLUSION: Acromegalic arthropathy is one of acromegaly's most critical functional disabilities. In our case, radiographic imaging studies at joint sites show severe osteoarthritis. Considering the patient's medical history, the cause of knee pain is osteoarthritis, which is also caused by acromegaly. We should also be aware that; long-term biochemical control of acromegaly may not prevent the progression of acromegalic arthropathy in many patients. The prevalence of clinical and radiological acromegalic osteoarthritis of the hip, hand and knee reaches even up to 80%. [Figure: see text]