About the PhD thesis

Acromegaly is a rare hormonal disorder caused by hypersecretion of growth hormone (GH) from a somatotroph pituitary adenoma. This causes a hypermetabolic state, partly mediated by GH-stimulated insulinlike growth factor I production, characterized by fluid retention, insulin resistance and excessive growth of soft and solid tissues.

Acromegaly causes universal growth of joint cartilage and osteophytosis, leading to painful osteoarthritis in nearly all patients, which severely affects quality of life. These growth abnormalities are not fully reversible but may be mitigated by control of the disease. Due to the rarity of acromegaly, the occurrence of acromegalic arthropathy has not been studied on a large scale, nor the prevalence of joint replacement therapy. Acromegalic arthropathy has been studied using common imaging techniques such as plain radiographs and magnetic resonance imaging (MRI), but the pathological joint changes associated with this condition have never been studied using high-resolution peripheral quantitative computed tomography; a promising imaging technique commonly used to characterize joint features in rheumatological joint diseases due to its unparallelled level of detail.

Bone disease in acromegaly is characterized by severely compromised trabecular bone structure, leading to increased risk of vertebral fractures. However, bone densitometry as measured by dual X-ray absorptiometry can be normal or even elevated – even in the presence of reduced bone quality.

Finally, balance and fall risk in acromegaly have been sparsely studied, but may cause considerable morbidity, particularly in the setting of reduced bone quality.

The present thesis addresses the epidemiological and clinical characteristics of bone and joint disease, and fall risk in acromegaly, including osteoarthritis risk and fea-tures, risk of joint replacement surgery, bone quality, balance and fall risk, and use of pain medication. Thus, the work presented herein thoroughly characterizes these conditions, from the joint spaces of individual hand joints to the risk of osteoarthritis at a national cohort level.
The results indicate significantly decreased bone and joint quality in patients with acromegaly in addition to impaired balance and joint pain. Our findings suggest that awareness of joint disorders, fall risk and pain management is needed to improve the management of patients with acromegaly.