Abstract
Acromegaly is a relatively rare neuroendocrine disorder associated with diffuse hypertrophy
of bony and soft tissues due to growth hormone hypersecretion from a pituitary adenoma.
Acromegaly can also cause numerous pathological changes in the spine, including degenerative
osteoarticular disease, axial arthropathy, spinal stenosis, vertebral fracture and
diffuse idiopathic skeletal hyperostosis (Forestier’s disease). Ossified ligamentum
flavum (OLF) is a rare disorder that often presents as thoracic spinal stenosis, but
to our knowledge has never been described in patients with acromegaly. Previously,
no link has been established between these two entities. We present, to our knowledge,
the first reported case of OLF in a patient with acromegaly who presented with thoracic
spinal cord compression. OLF is a potential spinal manifestation of acromegaly and
should be considered in the differential diagnosis of spinal stenosis or spinal cord
compression in the context of growth hormone hypersecretion.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Clinical NeuroscienceAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Acromegalic axial arthropathy: a clinical case-control study.J Clin Endocrinol Metab. 2004; 89: 598-603
- High prevalence of arthropathy, according to the definitions of radiological and clinical osteoarthritis, in patients with long-term cure of acromegaly: a case-control study.Eur J Endocrinol. 2009; 160: 357-365
- Morbidity after long-term remission for acromegaly: persisting joint-related complaints cause reduced quality of life.J Clin Endocrinol Metab. 2005; 90: 2731-2739
- Osteopenia occurs in a minority of patients with acromegaly and is predominant in the spine.Osteoporos Int. 1997; 7: 226-230
- Spinal and peripheral bone mineral densities in acromegaly: the effects of excess growth hormone and hypogonadism.Ann Intern Med. 1989; 111: 567-573
- High prevalence of vertebral fractures despite normal bone mineral density in patients with long-term controlled acromegaly.Eur J Endocrinol. 2011; 164: 475-483
- Paravertebral ligamentous ossification: DISH, OPLL and OLF.Eur J Radiol. 1998; 27: 196-205
- Radiographic and pathologic features of spinal involvement in diffuse idiopathic skeletal hyperostosis (DISH).Radiology. 1976; 119: 559-568
- Simultaneous ossification of the posterior longitudinal ligament and ossification of the ligamentum flavum causing upper thoracic myelopathy in DISH: case report and literature review.Eur Spine J. 2011; 20: S195-S201
- New developments in our understanding of DISH (diffuse idiopathic skeletal hyperostosis).Curr Opin Rheumatol. 2004; 16: 287-292
- Pathophysiology and surgical strategies in the management of the ossified spinal ligaments.World Neurosurg. 2011; 75: 443-444
- Thoracic myelopathy caused by ossification of the ligamentum flavum clinicopathologic study and surgical treatment.Spine (Phila Pa 1976). 1991; 16: 280-287
- Growth/differentiation factor-5 induces osteogenic differentiation of human ligamentum flavum cells through activation of ERK1/2 and p38 MAPK.Cell Physiol Biochem. 2010; 26: 179-186
- Ossification process involving the human thoracic ligamentum flavum: role of transcription factors.Arthritis Res Ther. 2011; 13: R144
- Rare cause of thoracic myelopathy: ossified ligamentum flavum.J Clin Rheumatol. 2010; 16: 326-329
- Thoracic myelopathy secondary to ligamentum flavum ossification.Ann Acad Med Singapore. 2004; 33: 340-346
- Syringomyelia due to thoracic spinal stenosis with ossified ligamentum flavum–case report.Neurol Med Chir (Tokyo). 2011; 51: 157-159
- Choice of operative method for ossification of ligamentum flavum based on CT findings.Rinsho Seikeigeka. 1996; 31: 541-545
- Thoracic myelopathy caused by ossification of the ligamentum flavum: clinical features and surgical results in the Japanese population.J Neurosurg Spine. 2006; 5: 514-519
- Thoracic spondylosis: an unusual cause of myelopathy.Neurosurgery. 1987; 20: 589-593
Article info
Identification
Copyright
© 2013 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
