Alpaslan TUZCU, Ayşe Dicle TURHANOĞLU, Mithat BAHCECİ, Hatice Öztürkmen AKAY, Zülfü KARABULUT

The association of acromegaly and ankylosing spondylitis

Akromegali ve ankilozan spondilitin nadiren rapor edilmiştir. Bu iki hastalığın birlikteliği literatürde iki olgu sunumu ile gösterilmiştir. Akromegali ve ankilozan spondilit benzer klinik ve radiografik bulgulara sahiptir. Kalkaneal epin varlığı, entezopati, cauda equina sendromu gibi bulgular hem akromegalide hemde ankilozan spondilit de gözlenebilir. Bu olgu hem ankilozan spondilitin hemde akromegalinin klinik ve radyolojik bulgularına sahipti. Uçlarda büyüme, yüz yapısının bozulması, malokluzyon, glikoz tolerans testinden sonra baskılanmayan büyüme hormon düzeyinin olmasına ek olarak da bir hipofizer adenom varlığı akromegali tanısını destekleyen bulgulardı. Sabah tutukluğu, Schober ve Moll testinin pozitif olması, sedimentasyon yüksekliği ile birlikte dördüncü dereceden sakroileitin varlığı hastada akromegaliye ek olarak ankilozan spondilitin de varlığını göstermekteydi. Bu olgu sunumunda ankilozan spondilit ve akromegali tanısı konulan bir hasta tartışılmıştır.

Anahtar Kelimeler:

Spondilit, ankilozan, Akromegali

Ankilozan ve akromegali birlikteliği

Coexistence of acromegaly and anklosing spondylitis had been rarely reported. Only two case reports were described coexistence of two diseases in literature. These two diseases have some similar clinical and radiographic features. Calcaneal epin formation, enteshopathy and caude equina syndrome can be seen both acromegaly and ankylosing spondylitis. Our case had clinical and radiological features of both acromegaly and ankylosing spondylitis. Acral enlargement, coarsening of feature, malocclusion, non-suppressed growth hormone levels with oral glucose tolerance test and evidence of pituitary adenoma were support diagnose of acromegaly. Morning stiffness, positive Schober and Moll test, elevated erythrocyte sedimentation rate and grade 4 sacroiletis of the patient lead us to diagnose ankylosing spondylitis at the same time. In this case report, we aim to discuss interesting coexistence of two disease.

Keywords:

Spondylitis, Ankylosing, Acromegaly,

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1. Braun J, Bollow M, Sieper J. Radiologic diagnosis and pathology of the spondyloarthropathies.Rheum Dis Clin North Am. 1998;24:697-735. 2. Melo-Gomes JA, Viana-Queiroz M. Acromegalic arthropathy: a reversible rheumatic disease. J Rheumatol, 1987;14:393- 394. 3. Calin A, Garrett S, Whitelock H, et al. A new approach to defining functional ability in ankylosing spondilitis: The development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol, 1994; 21:2281-2285. 4.Calin A. Ankylosing spondylitis. In Maddison PJ, Isenberg DA, Woo P, Glass DN,editors. Oxford Textbook of Rheumatology, Second edition, volume 2. New York: Oxford University Press, 1998, pp:1058- 1070. 5. Dougados M, van der Linden S, Juhlin R, Huitfeldt B, Amor B, Calin A, Cats A, Dijkmans B, Olivieri I, Pasero G, et al. The European Spondylarthropathy study group preliminary criteria for the classification of Spondylarthropathy. Arthritis Rheum, 1991;34:1218-27. 6. Podgorski M, Robinson B, Weissberger A, Stiel J, Wang S, Brooks PM.. Articular manifestations of acromegaly. Aust NZ J Med, 1988 ;18:28-35. 7. Libermann SA, Björkengren AG, Hoffman AR Rheumatologic and skeletal changes in acromegaly. Endocrine Metab Clin North Am, 1992; 21:615-31. 8. Barozzi L, Olivieri I, De Matteis M, Padula A, Pavlica P. Seronegative spondylarthropathies: imaging of spondylitis, enthesitis and dactylitis. Eur J Radiol. 1998;27 1:S12-7. 9. Linden SVD, Heide DVD. Ankylosing Spondylitis. In: Ruddy S, Harris ED, Sledge C, editors. Kelley’s Textbook of Rheumatology, volume 2. Philadelphia: WB Saunders Company, 2001: pp:1039-1054. 10. Yoshioka K, Juji T, Shizume K. Acromegaly and HLA. Endocrinol Jpn, 1984; 31:375-6. 11. Prier A, Bloch-Michel H, Salomon A, Schanen A, Merlet C. Cauda equina syndrome and ankylosing spondylitis. Association with acromegaly. A myelographic and tomodensitometric study of the lumbar canal. Sem Hop,1983; 59:1243-7. 12. Ionescu N. Acromegaly associated with ankylopoetic spondylitis. Rev Rhum Mal Osteoartic, 1968 ;35:50-52.