Peripheral nervous system assessment in acromegaly patients under somatostatin analogue therapy

Alibaş, Hande; Yavuz, Dilek Gogas; Koytak, Pınar Kahraman; Uygur, Meliha Melin; Tanridag, Tulin; Uluç, Kayıhan

doi:10.1007/s40618-016-0522-9

Cited by 8 publications

(5 citation statements)

References 16 publications

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“…In line with previous reports, we did not find diabetes mellitus to further increase the risk for CTS in patients with acromegaly (35). Previous studies suggest that disease duration and biochemical activity of acromegaly might be risk factors for CTS (22,25,30,36). Biochemical activity could not be formally investigated in the current study due to the lack of biochemical data.…”

Section: Discussionsupporting

confidence: 84%

“…In addition, altered oestrogen levels may play a role in the pathophysiology of CTS in women (35). However, previous smaller studies did not show any effect of gender or diabetes mellitus on the risk of CTS in patients with acromegaly (22,36). This large nationwide study is the first to show that female gender is an independent risk factor for CTS in patients with acromegaly.…”

Section: Discussionmentioning

confidence: 62%

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Carpal tunnel syndrome in acromegaly: a nationwide study

Vouzouneraki

Espósito

Mukka

et al. 2021

European Journal of Endocrinology

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Objective: Carpal tunnel syndrome (CTS) is common in patients with acromegaly, with a reported prevalence of 19–64%. We studied CTS in a large national cohort of patients with acromegaly and the temporal relationship between the two diagnoses. Design: Retrospective, nationwide, cohort study including patients diagnosed with acromegaly in Sweden, 2005–2017, identified in the Swedish Healthcare Registries. Methods: CTS (diagnosis and surgery in specialised healthcare) was analysed from 8.5 years before the diagnosis of acromegaly until death or end of the study. Standardised incidence ratios (SIRs) with 95% confidence intervals were calculated for CTS with the Swedish population as reference. Results: The analysis included 556 patients with acromegaly (50% women) diagnosed at mean (SD) age 50.1 (15.0) years. During the study period, 48 patients were diagnosed with CTS and 41 patients underwent at least one CTS surgery. Among the latter group, 35 (85%) were operated for CTS before the acromegaly diagnosis; mean interval (range) 2.2 (0.3–8.5) years and the SIR for having CTS surgery before the diagnosis of acromegaly was 6.6 (4.8–8.9). Women with acromegaly had a higher risk for CTS than men (hazard ratio 2.5, 95% CI 1.3–4.7). Conclusions: Patients with acromegaly had a 6-fold higher incidence for CTS surgery before the diagnosis of acromegaly compared with the general population. The majority of patients with both diagnoses were diagnosed with CTS prior to acromegaly. Increased awareness of signs of acromegaly in patients with CTS might help to shorten the diagnostic delay in acromegaly, especially in women.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 62%

Carpal tunnel syndrome in acromegaly: a nationwide study

Vouzouneraki

Espósito

Mukka

et al. 2021

European Journal of Endocrinology

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“…A correlation between the decreasing size of the median nerve and decreasing levels of IGF-I after the acromegaly treatment confirms the meaningful impact of IGF-I in CTS pathogenesis in acromegaly. Our findings are in agreement with those of other studies that describe the biochemical activity of acromegaly as a risk factor for CTS [ 21 – 23 ]. In our previous cross-sectional study on 107 acromegalic patients, we also found enlargement of the median nerve, which was proportional to the degree of IGF-1 levels but not dependent on the disease duration [ 19 ].…”

Section: Discussionsupporting

confidence: 93%

Changes in Cross-Sectional Area of the Median Nerve and Body Composition Parameters after Treatment of Acromegaly: 1 year Follow-Up

Ságová

Kantárová

Mokáň

et al. 2022

International Journal of Endocrinology

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Objective. Median neuropathy is a common manifestation of acromegaly, although its pathology is uncertain. Changes in levels of growth hormone (GH) and insulin-like growth factor I (IGF-I) and body composition are potential parameters in pathology of median neuropathy in acromegaly. We aimed to assess changes in the cross-sectional area (CSA) of the median nerve and body composition in newly diagnosed acromegalic patients 1 year after treatment and to determine their mutual relationships. Design. This prospective study included 30 patients with newly diagnosed acromegaly and 30 healthy controls matched for age, gender, and body mass index. Physical and laboratory examinations, dual-energy X-ray absorptiometry (DXA), and ultrasound evaluations were performed at baseline and 1 year after initial treatment. Results. The CSA of the median nerve was increased in acromegalic patients compared with controls (13.1 mm2 [12.2–14.9] vs 7.5 mm2 [6.4–8.4], P < 0.001 ). One year after treatment of acromegaly, GH and IGF-I levels decreased significantly. The median nerve CSA was significantly reduced after treatment (11.6 mm2 [10.2–13.1], P < 0.001 ). Reduction of IGF-I levels correlated with a decrease in lean mass and increase in fat mass. The median nerve CSA positively correlated with IGF-I levels (R = 0.492, P = 0.006 ) and lean mass (R = 0.419, P = 0.021 ) in acromegalic patients before treatment. Conclusion. This study demonstrates a reduction in the median nerve CSA 1 year after treatment of acromegaly. These changes are closely associated with a reduction in IGF- I levels and in lean body mass. The enlargement of the median nerve in acromegaly can be reversed with adequate treatment.

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“…No differences were found between diabetic and non-diabetic patients. 16 Pathogenesis of neurological conditions in acromegaly could be related both to concurrent DM or hypersomatotropism by itself. Possible explanations are compression of the nerves due to hypertrophic connective or bone tissue, and swelling of the nerve.…”

Section: Discussionmentioning

confidence: 99%

Sciatic neuropathy in an acromegalic cat without concurrent diabetes mellitus

Corsini

Bianchi

Volta

et al. 2020

Journal of Feline Medicine and Surgery Open Reports

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Case summary A 17-year-old neutered male European Shorthair cat was presented owing to an inability to jump and respiratory stridor. The owner did not report any other clinical signs. On physical examination, the main findings were plantigrade stance, broad facial features and inspiratory stridor. Neurological examination revealed posterior paraparesis, hypotonia and right hindlimb muscle atrophy. Laboratory findings were unremarkable and glycaemia was normal. Serum insulin-like growth factor 1 concentration was elevated (>1000 ng/ml). A total body CT scan showed an enlarged pituitary gland, thickening of the nasal turbinates and an L7–S1 right foraminal stenosis. Electrodiagnostic testing confirmed the presence of a neuropathy affecting both sciatic nerves. The cat was treated with gabapentin only and was still alive and euglycaemic 16 months after the diagnosis. Relevance and novel information This case describes for the first time sciatic neuropathy, an occasional complication of acromegaly in people, as a possible clinical presentation in acromegalic cats without concurrent diabetes mellitus.

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Peripheral nervous system assessment in acromegaly patients under somatostatin analogue therapy

Abstract: Our findings emphasize the high prevalence of peripheral nervous system involvement in acromegaly patients under SSA therapy and importance of neurological evaluation of these patients. Early diagnosis and treatment of the disease may reduce the PNS involvement.

Cited by 8 publications

References 16 publications

Carpal tunnel syndrome in acromegaly: a nationwide study

Carpal tunnel syndrome in acromegaly: a nationwide study

Changes in Cross-Sectional Area of the Median Nerve and Body Composition Parameters after Treatment of Acromegaly: 1 year Follow-Up

Sciatic neuropathy in an acromegalic cat without concurrent diabetes mellitus

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