[Osteoarticular manifestations in adrenal insufficiency]

We conducted a prospective study of the rheumatological manifestations in 20 patients with adrenal failure: 15 women and 5 men with a mean age of 56. Osteo-articular pathology was observed in 19 of the 20 cases (95%). The painful manifestations presented as arthralgia, myalgia or episodes of peri-arthritis; they were associated with active phases of the endocrine disease in 9 cases (45%). The radiological features of these patients were compared with those of age and sex matched controls who were hospitalized for other rheumatological conditions. 11 patients had radiologically visible tendinous calcifications (TC); 6 patients had 3 or more TC. The 20 patients had a total of 31 TC, which was significantly different from the controls. A related finding was calcification of the cartilages of the ears in 4 out of 10 patients (40%). Hypercalcaemia was detected in 5 cases (25%), accompanying episodes of decompensation of the adrenal failure. The pathogenesis of the tendinous calcifications is not clear. Mineralocorticoid treatment can not be considered to be a major aetiological factor for CT, calcification of the ears nor the pain, as its use was very constant. Thus, tendinous calcifications, which have rarely been reported to date, could explain a large part of the painful manifestations of adrenal failure.