Frequency of hyperostosis frontalis interna in patients with active acromegaly: is there a possible role of GH excess or hyperprolactinemia in its etiopathogenesis?

Hormones (Athens). 2023 Mar;22(1):25-32. doi: 10.1007/s42000-022-00401-x. Epub 2022 Oct 12.


Purpose: Acromegaly is characterized by bone changes due to excessive growth hormone (GH) secretion. Hyperostosis frontalis interna (HFI) is described as an overgrowth in the inner plate of the frontal bone. An increased incidence of HFI has been reported in patients with acromegaly. Since the etiology of HFI is poorly understood, we have analyzed whether there is a relationship between the hormonal and metabolic status of patients with acromegaly (with or without hyperprolactinemia) and the pathogenesis of HFI.

Methods: Forty-five patients with acromegaly and two control groups consisting of 25 patients with prolactinoma (group 1) and 47 healthy subjects (group 2) were included in this retrospective study. Baseline hormonal data and cranial imaging were obtained from medical records and analyzed.

Results: Mean frontal bone thickness was 6.75 mm in acromegaly, 4.85 mm in group 1, and 5.1 mm in group 2 of controls (p < 0.001). The frequency of HFI was higher in acromegalic patients than in the controls (22%, 0%, and 2.2%, respectively). There was no difference between the HFI positive and negative acromegalic patients in basal GH, IGF-1, and PRL levels, IGF-1 index, diagnosis lag time, and insulin resistance. There was no difference between groups regarding parietal and occipital bone thickness.

Conclusion: Although the frequency of HFI is 22% in patients with acromegaly, neither excess GH nor hyperprolactinemia plays a role in its etiopathogenesis. Various genetic or epigenetic factors may contribute to its etiology.

Keywords: Acromegaly; Frontal bone thickness, Hyperprolactinemia; Hyperostosis frontalis interna; Prolactinoma.

MeSH terms

  • Acromegaly* / complications
  • Acromegaly* / pathology
  • Frontal Bone / pathology
  • Gigantism*
  • Humans
  • Hyperostosis Frontalis Interna* / epidemiology
  • Hyperostosis Frontalis Interna* / etiology
  • Hyperostosis Frontalis Interna* / pathology
  • Hyperprolactinemia* / complications
  • Insulin-Like Growth Factor I
  • Retrospective Studies


  • Insulin-Like Growth Factor I

Supplementary concepts

  • Growth hormone excess