Endocrine Arthropathies

Michael D. LockshinH

KEY POINTS

The musculoskeletal manifestations of endocrine diseases include muscle dysfunction, disorders of bone metabolism, and cartilage deformation.
Endocrinopathic musculoskeletal disease tends to be diffuse and poorly described.
The most important diagnostic step is to consider the possibility of endocrinopathy.
Routine clinical laboratory tests are usually not helpful; radiographs often first suggest the possibility of an endocrinopathy.
Treatment of the underlying endocrinopathy relieves the musculoskeletal manifestations; however, the rate of remission varies with the endocrinopathy.

The musculoskeletal manifestations of endocrine diseases include muscle dysfunction, disorders of bone metabolism, and cartilage deformation.

Tendons, ligaments, and tendon attachment sites are regularly symptomatic for example symptoms are more often periarticular than articular. Crystal arthropathies and calcific tendinitis may be symptoms of endocrine disease.

CLINICAL MANIFESTATIONS

Endocrinopathic musculoskeletal disease tends to be diffuse and poorly described.

Except for crystal arthritis, it is more often periarticular than articular. Table 55-1 lists the rheumatic manifestations of common endocrinopathies.

Table 55-1 Rheumatic Manifestations of Common Endocrinopathies

Endocrine abnormality	Rheumatic Manifestations	Putative pathogenesis
Thyroid—hyper	Proximal myopathy Thyroid acropachy Myalgia (during changing thyroid states)	Muscle/protein metabolism Growth hormone Unknown
Thyroid—hypo	High creatine kinase Bland joint effusion Chondrocalcinosis Hyperuricemia Myalgia (during changing thyroid states) Osteonecrosis-type joint damage that may necessitate joint replacement	Muscle membrane abnormality Abnormal cartilage metabolism Unknown Renal tubular dysfunction Unknown Unknown
Parathyroid—hyper	Osteopenia, bone resorption, fractures, cysts, myopathy, and pseudogout	Hypercalcemia increased osteoclast activity
Parathyroid—hypo	Osteopenia	Decreased osteoblast activity
Parathyroid—hypo (congenital)	Short stature and short metacarpals	Unknown
Pituitary—hyper	Increased cartilage growth, accelerated osteoarthritis, and osteopenia	Growth hormone excess and abnormal joint mechanics
Pituitary—hypo	Short stature and osteopenia	Lack of growth hormone
Adrenal—hyper	Osteopenia	Effect on calcium metabolism and osteoblasts and osteoclasts
	Proximal myopathy	Muscle protein catabolism and hypokalemia
Gonads—hyper	Short stature	Premature closure of epiphyses
Gonads—hypo	Osteopenia	Unopposed osteoclast activity
Pancreas (diabetes)	Charcot joints Eheiroarthropathy Dupuytren’s contracture Palmar fasciitis Carpal tunnel syndrome Septic arthritis or osteomyelitis Scleredema	Neuropathy Unknown Unknown Unknown Unknown Increased infection risk in DM Unknown
Hemochromatosis	Pyrophosphate arthropathy Hooks on metacarpophalangeal Joints	Iron deposition in cartilage Unknown
DM, diabetes mellitus.