Posters
« Back
152:TMD and Facial Pain Secondary to Acromegaly{AAOM2021}
EP36041
Poster Title: 152:TMD and Facial Pain Secondary to Acromegaly{AAOM2021}
Submitted on 29 Mar 2021
Author(s): Malak Adel Alhadlaq, Herve Y Sroussi
Affiliations: Harvard School of Dental Medicine, United States of America
This poster was presented at 2021 American Academy of Oral Medicine Virtual Conference
Poster Views: 155
View poster »


Poster Information
Abstract: Background: Acromegaly is a chronic multisystem condition of somatic overgrowth secondary to excessive production of growth hormone in adults. Increased levels of growth hormone clinically manifest as hypertrophy of soft and hard tissues with physical and functional changes. Skeletal disorders, such as arthropathies, are the primary factor affecting the quality of life in most patients. Acromegalic arthropathies most commonly involve large joints: hands, shoulders, knees, and hips. The temporomandibular joint (TMJ) can be involved as well resulting in temporomandibular joint disorder (TMD) and associated facial pain. The current literature is unclear as to the significance of TMD and its often associated facial pain complaints towards the diagnosis or staging of acromegaly. The prevalence of TMD in acromegaly is also unknown.

Case Summary: We present a case of an otherwise generally healthy 39 year old male with TMD and myofascial pain as the leading manifestation related to acromegaly secondary to a pituitary macroadenoma. The patient presented to our clinic with a chief complaint of recent left-sided facial and jaw pain characterized by constant pressure and tightness around the TMJ with evidence of degenerative remodelling on MRI. Conservative management with muscle relaxant, analgesics, and physical therapy failed to improve symptoms. Months later, the patient was hospitalized for severe hyponatremia and found to have hypothyroidism and adrenal insufficiency suspicious for pituitary apoplexy. CT and MRI confirmed presence of a pituitary adenoma and laboratory investigation showed elevated IGF-1 level. Following tumor resection and normalization of growth hormone levels, symptoms related to TMD and associated facial pain resolved completely.

Conclusions: It is important for dentists, particularly oral medicine and orofacial pain specialists, to be aware of TMJ involvement in acromegalic arthropathy. TMD and related orofacial pain can be a sign of acromegaly in its initial presentation as presented above. It is of significance to consider acromegalic arthropathy in the correct clinical setting as a differential diagnosis for TMD warranting further investigation to achieve early diagnosis of acromegaly and improve disease prognosis. Furthermore, management of TMD and facial pain secondary to acromegaly and control of clinical symptoms relies on correction of the underlying endocrinopathy.
Summary: It is important for dentists, particularly oral medicine and orofacial pain specialists, to be aware of TMJ involvement in acromegalic arthropathy TMD and related orofacial pain can be a sign of acromegaly in its initial presentation as presented.

Ask the author questions about this poster:mal-hadlaq@partners.org
References: 1. Melmed, S. (2006). Acromegaly. The New England Journal of Medicine, 355(24), 2558-2573.
2. Bennett, R. (2005). Growth hormone in musculoskeletal pain states. Current Pain and Headache Reports, 9(5), 331-338.
3. Lavrentaki, A., Paluzzi, A., Wass, J.A.H., Karavitaki, N. (2017). Epidemiology of acromegaly: Review of population studies. Pituitary, 20(1), 4-9.
4. Katznelson, L., Atkinson, J.L.D., Cook, D.M., Ezzat, S.Z., Hamrahian, A.H., Miller, K.K. (2011). American Association of Clinical Endocrinologists medical guidelines for clinical practice for the diagnosis and treatment of acromegaly--2011 update. Endocrine Practice, 17 Suppl 4(Supplement 4), 1-44.
5. Biermasz, N.R., Pereira, A.M., Smit, J.W.A., Romijn, J.A., Roelfsema, F. (2005). Morbidity after Long-Term Remission for Acromegaly: Persisting Joint-Related Complaints Cause Reduced Quality of Life. The Journal of Clinical Endocrinology and Metabolism, 90(5), 2731-2739.
6. Vilar, L., Vilar, C.F., Lyra, R., Lyra
Report abuse »
Creative Commons