Rheumatic manifestations of acromegaly

Acromegaly is a chronic endocrine disease characterized by excessive secretion of growth hormone (GH), which, in turn, leads to increased insulin-like growth factor 1 (IGF-1) secretion by the liver. GH and IGF-1 excess leads to excessive cell and tissue growth, including the osteoarticular apparatus. Joint pain in acromegaly is a frequent and early symptom. In some cases, joint manifestations can be one of the first signs of acromegaly and their intensity increases with duration of the active disease. Estimated prevalence of joint damage signs is around 70% of patients at the time of diagnosis of acromegaly. Musculoskeletal system alterations can manifest either in axial skeleton and peripheral joints. Besides arthropathy, patients with acromegaly (both active and controlled) are more prone to vertebral fractures, although it was previously thought that acromegaly has a low risk of osteoporosis. In this article, we review features of damage to the axial skeleton, peripheral joints in the setting of excessive GH and IGF-1 production, as well as the association of autoimmune rheumatic diseases and acromegaly

Raynaud’s phenomenon in the endocrinologist’s practice

Raynaud’s phenomenon or syndrome (RS) is an episodic attacks of transient digital ischemia resulting from vasospasm of the digital artery, precapillary arterioles, and skin arteriovenous shunts in response to exposure to cold temperature or emotional stress. Prevalence averages 3–5%. The high prevalence of RS in the population, as well as the frequent association with other, often life-threatening, diseases and conditions, determines its clinical significance. In 80–90% of cases, RS is idiopathic. It is assumed that the spasmodic reactivity of the vessels is caused by a violation of the central and local dysregulation of vascular tone. The most important role is played by vascular endothelial, intravascular and neuronal disorders. In at least 10% of cases, this is a secondary phenomenon. Most often, RS is associated with systemic rheumatic diseases. Along with this, endocrine diseases can develop, including those affected by the pituitary, thyroid and parathyroid glands, adrenal glands, and diabetes mellitus. In some cases, RS may be the only symptom of endocrine pathology. In general, SR is a condition with a favorable outlook and a stable course. The most informative instrumental method for the differential diagnosis of primary and secondary syndrome is the capillaroscopy of the nail bed

Limited joint mobility syndrome as a predictor of the diabetic foot syndrome

Diabetes mellitus (DM) can lead to the development of late complications. In addition to the traditional late complications, a high prevalence of damage to the musculoskeletal system in diabetes was noted. The most appropriate term that reflects the defeat of the musculoskeletal system in diabetes is limited joints mobility syndrome (LJM). Damage to the hands in the presence of open painless stiffness of the joints, fixed flexion contractures, impaired fine motor skills of the hands and grip forces. Subsequently, it became clear that, over time, the restriction of joint mobility develops not only in the small joints of the hands, but also in other large and small joints of the limbs. Traditionally, LJM syndrome pays low attention on the part of practitioners in comparison with other micro- and macrovascular complications of diabetes, even though LJM can significantly impair functional activity, self-care, and impair the quality of life. It is assumed that damage to the periarticular tissues and joints in DM is caused by the accumulation of end glycation products. A decisive place in the diagnosis of LJM is the clinical examination. In the presence of LJM syndrome, the osteoarticular structures of the feet can be affected, timely diagnosis can lead to the development of diabetic foot syndrome

Helicity-dependent photocurrents in graphene layers excited by mid-infrared radiation of a CO2_2-laser

We report the study of the helicity driven photocurrents in graphene excited by mid-infrared light of a CO$_2$-laser. Illuminating an unbiased monolayer sheet of graphene with circularly polarized radiation generates -- under oblique incidence -- an electric current perpendicular to the plane of incidence, whose sign is reversed by switching the radiation helicity. We show that the current is caused by the interplay of the circular $ac$ Hall effect and the circular photogalvanic effect. Studying the frequency dependence of the current in graphene layers grown on the SiC substrate we observe that the current exhibits a resonance at frequencies matching the longitudinal optical phonon in SiC

Impurity breakdown and terahertz luminescence in n-GaN epilayers under external electric field

We report on the observation and experimental studies of impurity breakdown and terahertz luminescence in n-GaN epilayers under external electric field. The terahertz electroluminescence is observed in a wide range of doping levels (at noncompensated donor density from 4.5×10[sup 16] to 3.4×10[sup 18] cm[sup −3]). Spectra of terahertz luminescence and photoconductivity are studied by means of Fourier transform spectrometry. Distinctive features of the spectra can be assigned to intracenter electron transitions between excited and ground states of silicon and oxygen donors and to hot electron transitions to the donor states.Peer reviewe

The case of oncogenic hypophosphatemic osteomalacia

Osteomalacia is a systemic bone disease, characterized by an excessive accumulation of non-mineralized osteoid and an imbalance in the organic matrix formation and mineralization. A rare cause of disease is tumor-induced osteomalacia, most often due to phosphaturic mesenchymal tumors (PMT). Usually there are benign small tumors, affecting the soft tissues and bones of any location. The basic pathogenesis of underlying oncogenic osteomalacia is a decreased renal tubular reabsorption of phosphate consequent to hyperproduction of fibroblast growth factor 23 in PMT. Clinical features are nonspecific, the average period from the symptoms onset to diagnosis reaches 3 years and at least 5 years before surgical treatment. Finding the tumour is crucial, as complete removal is curative. We present a clinical case of tumor-induced osteomalacia due to PMT required the complex differential diagnosis with other rare diseases

Joint and muscle involvement in primary hyperparathyroidism

In addition to the classical symptoms such as osteoporosis, renal stones and gastric ulcers primary hyperparathyroidism (PHPT) could be presented with non-classical manifestations, including muscle and joint pathology. Moreover, in some cases the articular and neuromuscular impairment might be the main signs of the disease. Despite the long research history the true prevalence of these PHPT complications remains unknown. Discrepancies in studies results may be due the non-specific and different symptoms that patients complain about, various study design, uncorrected comorbid conditions, the different PHPT populations, a wide methods variety in the assessment of neuromuscular and articular involvement. However, the underestimated muscle dysfunction and joint damage can lead to decreased quality of life and disability, primarily from fragility fractures. In the majority of the studies parathyroidectomy improved muscle strength, but there is no clear results for articular manifestations. Basic research and large randomized control trials are limited. The main goal of this review is to summarize currently available data on muscle and joint involvement in patients with PHPT

LIMITED JOINT MOBILITY SYNDROME IN DIABETES MELLITUS

Patients with diabetes mellitus (DM) often show changes in the locomotor apparatus (LMA), in particular cheiroarthropathy, a specific lesion of the connective tissue structures of the hand in the presence of persistent hyperglycemia, which leads to limited joint mobility (LJM) generally in the absence of pain syndrome. Some authors use the term «LJM syndrome» to describe LMA lesion in DM, since in the long course of the disease, the small and large joints of not only the upper, but also the lower limbs are involved in the pathological process. LJM is one of the little studied and poorly diagnosed conditions in comparison with traditional micro- and macro-vascular complications of DM, which, due to their direct correlation with life expectancy, receive more attention. The LJM syndrome is associated with other late complications of DM and can significantly impair functional activity, self-care, and quality of life. Damages to periarticular tissue and joints in DM are believed to be caused by the accumulation of glycation end products. A clinical examination plays a key role in the diagnosis of cheiroarthropathy

Riedel's thyroiditis: diagnostic difficulties (clinical case and brief review)

Riedel's thyroiditis is a rare disease characterized by chronic fibrosis. Clinical performance of this disease is dense stony goiter, which can poorly be displaced during palpation. The overgrowth of the goiter can lead to the development of compression syndrome. To diagnose we need to made fine needle biopsy and made the final diagnose according to its results or according to the morphological description of the postoperative material. An important step in the diagnosis of Riedel's thyroiditis is the determination of serum IgG and IgG4 to exclude an IgG4-associated disease. Treatment of this disease includes drug therapy, which is based on glucocorticosteroids administration or surgical treatment when develops compression syndrome. This article presents a clinical case of a patient with Riedel's thyroiditis; the main complaints were associated with the growth of goiter and the development of compression syndrome. In this regard, patient underwent surgery on the thyroid gland, and after this we get final diagnose. Due to feeling unwell, drug therapy with glucocorticosteroids was prescribed, against the background of which we noted a positive trend