Shoulder osteoarthritis facilitating the diagnosis of acromegaly.

Abstract

A man in his early 50s presented with mechanical chronic pain and limitation of the active range of motion of the right shoulder. Imaging of the shoulder showed osteophytosis without joint space narrowing or cranial migration of the humeral head. He reported no history of trauma, dislocation arthropathy, clinical or standard biological evidence for septic or inflammatory arthritis, metabolic, haemophilic or endocrine-associated arthropathies. The second medical consultation revealed enlargement and infiltration of hands and feet. Consequently, we suspected acromegaly, which was confirmed by endocrinological diagnosis. Further, an MRI of the pituitary gland showed a sellar tumour. The patient's shoulder pain was related to undiagnosed acromegalic arthropathy leading to osteoarthritis and was treated by trans-sphenoidal exeresis of the somatotroph adenoma and a somatostatin analogue. In conclusion, acromegaly should be considered in patients with centred glenohumeral osteoarthritis, as an early diagnosis is essential to limit complications and preserve the quality of life.