A 69-year-old man with acromegaly presented with dysphagia. He noticed enlarged feet in his 20s and facial changes were noted in his 40s. He had been treated with hormone replacement… Click to show full abstract
A 69-year-old man with acromegaly presented with dysphagia. He noticed enlarged feet in his 20s and facial changes were noted in his 40s. He had been treated with hormone replacement therapy for 20 years after two transsphenoidal surgeries. He had not received any other treatments for acromegaly. Laboratory tests showed increased levels of growth hormone (GH; 1.95 ng/mL) and insulin growth factor (IGF)-I (251 ng/mL; +2.8 SD). Cervical CT revealed osteophytes at C2-C7 (Picture A) with anterior and posterior longitudinal ligament ossification. C4/5 osteophytes (Picture B) compressed the pharynx on esophagogastroduodenoscopy (Picture C) and induced barium residue in the pyriform sinus on videofluoroscopy (Picture D), which caused dysphagia. Chronic excess levels of GH and IGF-I in acromegaly cause osteoarticular involvement called acromegalic arthro-
               
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