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Trigger Finger Induced by Growth Hormone Supplements in a Muscular Man.

CASE DESCRIPTION A 55-year-old muscular man presented with a complaint of snapping of the ring fingers of both hands and the right middle finger of 1-week duration. The patient reported that he was receiving intramuscular somatotropin injections (Somatropin 10mg) for 10 weeks prior to presentation. He used 10 injections in total. He had not noticed any characteristic features of acromegaly such as a large mandible or prominent forehead. On physical examination, the patient had restricted range ofmovement of his ring fingers and right middle finger with a triggering effect. The hands appeared broad and spade-like. Growth hormone (GH) injections were discontinued after the clinical visit. An ultrasound of the fingers, using a high-resolution linear probe (5–18 MHz), showed tenosynovitis of variable degrees, involving multiple tendons (Fig., A and B). The symptoms resolved within 1 month after discontinuing the medication. Growth hormone may be abused for its function as a performance-enhancing drug or as a treatment for GH deficiency syndrome. Because it has been linked to a variety of adverse effects such as acromegalic features, close monitoring throughout the treatment is necessary. Acromegaly is the general condition of excess GH and includes overgrowth of parts of the skeleton and other tissues. Trigger finger is an early clinical manifestation found in 25% of