Radiographic findings in acromegaly: pictorial essay

Abstract

Acromegaly is an uncommon metabolic disorder, often diagnosed after a long delay. One symptom seen in many patients with acromegaly is arthralgia, a finding that calls for the use of conventional radiography, which can reveal subtle changes that can go unnoticed. The objective of this pictorial essay is to portray the radiographic aspects of acromegaly, seeking to demonstrate the importance of conventional radiography, which, despite its simplicity, can suggest the diagnosis, even in the early stages, thus altering the clinical course of the disease.

Keywords: Acromegaly; Arthralgia; Radiography.

Figure 1

Radiograph of the left hip, in an anteroposterior view, showing an increase in the femoroacetabular joint space in a patient with acromegaly (A), compared with the normal space in a healthy patient (B).

Figure 2

Radiograph of the hallux of a patient with acromegaly, showing a coarse, beak-like enthesophyte (arrow) at the base of the proximal phalanx, the insertion site of the medial collateral ligament of the metatarsophalangeal joint. Note also the hypertrophy of the sesamoid bones (asterisks).

Figure 3

A: Radiograph of the skull, in a lateral view, of a patient with acromegaly, showing increased thickness of the frontal bone (dotted arrow) and forehead prominence (arrowhead), as well as increased dimensions of the frontal sinus (asterisk) and enlargement of the sella turcica (arrow). B: Lateral radiograph of the skull of a healthy patient, with preserved frontal bone thickness (dotted arrow), as well as normal dimensions of the frontal sinus (asterisk) and sella turcica (arrow). C: Gadolinium contrast-enhanced, fat-saturated, sagittal T1-weighted magnetic resonance imaging scan of the same patient depicted in panel A, showing pituitary macroadenoma (arrow), which was responsible for the enlargement of the sella turcica.

Figure 4

A: Conventional radiograph, in an anteroposterior view, of the right hand of a patient with acromegaly, showing hypertrophy of the terminal tufts of the distal phalanges, forming projections similar to spurs (arrow), as well as enlargement of the bases of those phalanges (arrowheads) and a slight increase in the size of the sesamoid bone (asterisk). Note also the prominence of the soft tissues around the fingers. B: Conventional radiograph, in an anteroposterior view, of the right hand of a healthy patient, for comparison.

Figure 5

A: Radiograph showing the spade-like appearance of the distal phalanx, caused by enlargement and hypertrophy of the terminal tuft, in the hand of a patient with acromegaly. B: Schematic drawing of a spade.

Figure 6

Radiograph of the distal phalanges in the foot of a patient with acromegaly, showing marked hypertrophy of the bases and terminal tufts, leading to the formation of a pseudoforamen (arrowheads).

Figure 7

A: Radiograph of the distal phalanx of the hand of a patient with acromegaly, showing hypertrophy of the terminal tuft, with a spade-like appearance, together with widening of the base of the phalanx (arrowheads). B: Radiograph of the distal phalanx with a spade-like appearance but without significant widening of the base, suggestive of a normal variant. C: Radiograph of the distal phalanx in a healthy patient, showing no alterations.

Figure 8

Radiographs illustrating abnormalities of the foot. Note the hyperconstriction of the proximal phalanges of the second to fourth fingers of a patient with acromegaly (arrows in A) in relation to those of a healthy patient (B). Additional findings in the patient with acromegaly included soft tissue enlargement (asterisk), prominence of the tufts and bases of the terminal phalanges, a pseudoforamen, enlargement of some of the metatarsophalangeal joints and prominence of the sesamoid bones of the hallux.

Figure 9

Radiograph of the foot, in a lateral view, showing increased thickness of the plantar fat pad of the foot of a patient with acromegaly (A) compared with that of a healthy patient (B).