Radiological features and diagnosis of acromegaly.

The most constant radiological features of acromegaly include soft tissue hyperplasia, and increased joint spacing, especially in the limbs by articular cartilage overgrowth. Overgrowth is variable in bone. Despite the closure of the epiphysis, articular endochondral overgrowth and subsequent ossification does occur at specific sites as pseudoepiphyseal linear growth. The combined bony apposition-remodeling resorption mechanism, rather than a true osteoporosis, may involve the skull, extremities and spine. Radiological features of the spine have scarcely been reported. The clinical significance of hyperostosis of the spinous process for chronic backache, and vertebral scalloping to compensate for entrapment myelopathy and/or cauda equina syndrome or radiculopathy are overlooked. Further series of radiological assessment of the spine by noninvasive CT scans and plain radiography are recommended. The diagnosis of acromegaly is discussed from a literature review. Deep facial skin-crease testing and dorsal skin-fold assessment of the extremities are recommended as initial screens for evidence of soft tissue hyperplasia.