Long-term growth hormone use potentially linked to anterior cervical osteophyte-related dysphagia in 62-year-old male

Anterior cervical osteophytes, bony growths on the vertebrae, can compress the esophagus, leading to dysphagia (difficulty swallowing). While common in older adults, symptomatic osteophytic dysphagia is often underdiagnosed. The precise role of systemic anabolic factors, such as growth hormone (GH), in promoting osteophyte growth and their contribution to clinically significant symptoms remains poorly characterized. Understanding this potential link is crucial for clinicians managing patients with cervical spondylosis and those using anabolic substances, as current standard-of-care primarily focuses on mechanical relief or surgical intervention without fully addressing potential underlying systemic drivers.

This case report describes a 62-year-old male ex-military recreational bodybuilder presenting with cervicalgia and left shoulder pain. His medical history included a cervical injury from jiu-jitsu training in 2001-2002. He reported approximately 20 years of patient-reported exogenous growth hormone and GH secretagogue use, including cyclical somatropin, sermorelin/GHRP-6 combination therapy, and ongoing nightly somatropin. Cervical radiographs and MRI were performed to evaluate his pain, revealing multilevel degenerative changes. No objective swallowing evaluation was conducted due to the mild, intermittent nature of his dysphagia symptoms.

Imaging revealed multilevel degenerative changes in the cervical spine, notably a prominent anterior osteophyte located at C3-C4. This osteophyte was observed to cause significant esophageal compression, consistent with the patient's reported symptoms. On directed questioning, the patient disclosed intermittent dysphagia specifically with larger food boluses. The authors hypothesized that the patient's chronic GH axis stimulation, resulting from 20 years of exogenous growth hormone and GH secretagogue use, in conjunction with his remote cervical trauma, may have contributed to the clinically significant osteophyte formation and subsequent dysphagia. This observation suggests a potential link between long-term anabolic substance use and accelerated degenerative changes.

The case highlights a prominent anterior osteophyte at C3-C4 causing esophageal compression, raising the hypothesis that chronic GH axis stimulation may contribute to clinically significant osteophyte formation.