Does acromegaly cause acroosteolysis of the digits?

• A. Yes
• B. No
• C. Only in childhood
• D. Rarely

Answer: (B)

The concept to grasp is what acroosteolysis means and how acromegaly alters bone, especially in the digits. Acroosteolysis is the resorption or destruction of the distal tips (tufts) of the distal phalanges. In acromegaly, the problem is excess growth hormone driving overgrowth of soft tissues and bone, particularly at the ends of the skeleton. The digits typically become enlarged due to soft tissue swelling and bone overgrowth (periosteal there’s widening and spurring, with degenerative joint changes), not because the distal phalangeal tufts are resorbed. Therefore acroosteolysis does not occur with acromegaly. Conditions that do show acroosteolysis include systemic sclerosis (scleroderma), hyperparathyroidism, frostbite, and some vascular or thermal injuries, where the distal phalanges actually erode away.