Acromegalic arthropathy (AA) denotes a chronic degeneration of axial or peripheral joints because of acromegaly, which is caused by an excessive production of growth hormones. Early AA is noninflammatory and gradually develops typical osteoarthritic symptoms in later stages. Long-lasting joint pain in hips, shoulders, knees, hands or elbows, as well as a backache and unexplained headache, may indicate an early stage of AA.
Early recognition of AA is imperative since joint degenerations are irreversible in later stages and can only be partly reversed by growth hormone regulation therapies.
Acromegalic arthropathy often runs unnoticed for a long time in patients with diffuse and unspecific pain in axial or peripheral joints and in the back. General morning stiffness is also frequently reported. Pain episodes can last from weeks to months. Back pain is typically located in the lumbosacral part with rare involvement of the thoracic and cervical parts  .
The pain sensation is caused by persistently elevated somatotropin and insulin-like growth factor 1 (IGF-1) levels . The reason for elevated growth hormone levels is often a pituitary tumor or in rare cases an ectopic source of growth hormone production. AA usually persists after tumor removal. AA is progressive and only reversible in early stages. In the initial phase, patients may present with bone, cartilage and soft tissue hypertrophy, peripheral nerve enlargement and carpal tunnel syndrome. Arthropathic symptoms are usually the first indication for acromegaly. 70% of cases suffer from AA complaints at the time of the diagnosis. AA is often diagnosed together with diabetes mellitus, hypertension and arthritis  .
In principle, all bones and joints can be affected by the endocrine disorder. However, most frequent degenerations involve hips, shoulders, knees, hands or elbows. Excess growth hormone in AA victims leads to an increased bone mineral density (BMD), which may be related to a reduced fracture risk . In the further progression of AA, irreversible joint degeneration leads to a significant impairment of the patient's joint mobility. However, back mobility has been reported to be spared and sometimes even enhanced in AA .
Acromegalic arthropathy diagnosis is based on the thorough history, physical examination, radiography and laboratory tests.
A reported combination of persisting and long-lasting joint pain, unspecific back pain and unexplained headache episodes should guide the clinical investigations. An immediate assessment of joint swelling, crepitus, tissue tenderness near the affected joint and joint mobility is indicated because a thickening of periarticular tissues is often described  .
Bone hypertrophy can be assessed with radiography. Increased cartilage thickness, widened joint spaces and the observation of osteophytosis near joint margins in knees and hips and in the intracondylar notch of knees. Osteophytosis has also been reported in thoracic and lumbar vertebrae along with frequent dorsal kyphosis. Synovial effusion is rare but possible .
Diagnosis must be finalized with irrefutable proof of elevated serum growth hormone (GH) and IGF-1 levels. Only a random GH value of less than 0.04 µg/l can definitely rule out AA. The best evidence is provided by the inability to suppress GH secretion to less than 1 µg/l within 2 hours after an oral glucose load of 75 g. Further endocrinological workup may be required to control excess growth hormone production   .