Screening for Acromegaly in Patients with Carpal Tunnel Syndrome: A Prospective Study (ACROCARP)

Abstract

Early diagnosis of acromegaly prevents irreversible comorbidities and facilitates surgical cure. Carpal tunnel syndrome (CTS) is common in acromegaly and patients have often undergone surgery for CTS prior to the diagnosis of acromegaly. We hypothesized that screening CTS-patients for acromegaly could facilitate active case-finding. We prospectively enrolled 196 patients [135 women, 56.9 (range 23-103) years] who presented with CTS for surgery. Patients were asked about 6 symptoms suggestive of acromegaly using a questionnaire calculating a symptom score (0-6 points), and insulin-like-growth factor 1 (IGF-1) was measured. If IGF-1 was increased, IGF-1 measurement was repeated, and random growth hormone (GH) and/or an oral glucose tolerance test (OGTT) with assessment of GH-suppression were performed. The mean symptom score was 1.7±1.3 points. Three patients reported the maximal symptom score of 6 points, but none of them had an increased IGF-1. There was no correlation between the symptom score and IGF-1-SDS (standard deviation score) (r=0.026; p=0.71). Four patients had an IGF-1>2 SDS. In 2 patients acromegaly was ruled out using random GH and OGTT. One patient had normal IGF-1 and random GH at follow-up. One patient refused further diagnostics. In this prospective cohort of patients with CTS, the observed frequency of acromegaly was at most 0.51% (95% CI 0.03 to 2.83%). In this prospective study, none of the 196 patients with CTS had proven acromegaly. Thus, we see no evidence to justify general screening of patients with CTS for acromegaly.

Acromegaly in sleep apnoea patients: a large observational study of 755 patients

“…Previous studies that screened for acromegaly in the general population [11], and in hypertensive [12], diabetic [3] or carpal tunnel syndrome patients [13] found similar results to ours. In patients with existing comorbidities, the only clinical indicators of acromegaly are obvious facial dysmorphism and enlargement of the extremities.…”

Ultrasound Elastography of the Median Nerve in Patients With Acromegaly: A Case‐Control Study

“…Previous studies have reported that approximately four‐fifths of patients with acromegaly have subclinical abnormalities on electrodiagnostic tests, and up to 64% have symptomatic CTS. Although a substantial improvement in symptoms has been seen when the growth hormone levels are diminished, the exact physiopathologic mechanism has not been clarified . An increase in the size of the median nerve or cross‐sectional area has been studied with both magnetic resonance imaging and US .…”

“…Although a substantial improvement in symptoms has been seen when the growth hormone levels are diminished, the exact physiopathologic mechanism has not been clarified. [1][2][3]12 An increase in the size of the median nerve or cross-sectional area has been studied with both magnetic resonance imaging and US. 8,12,13 Ultrasound imaging has shown swelling of the nerve proximal to the entrapment site, 7,10 and magnetic resonance imaging has shown increased signal intensity on T2-weighted images.…”

“…C arpal tunnel syndrome (CTS) and other peripheral nerve problems are common in patients with acromegaly. [1][2][3] Although typical clinical signs and symptoms (ie, pain and sensorial disturbance along the median nerve distribution or muscle atrophy in advanced stages) indicate CTS, electrodiagnostic testing is required to confirm the diagnosis and to determine the location and severity of the CTS. 4 Ultrasound (US) has previously been established as a convenient modality for the imaging of peripheral nerves and diagnosis of CTS, with several advantages.…”

Selective screening of patients with associated somatic diseases as a method of early detection of acromegaly

“…Нельзя не затронуть и фармакоэкономические аспекты, поскольку стоимость лечения осложнений намного превышает затраты на курацию основного заболевания [39]. • карпальным туннельным синдромом (ACROCARP) [50].…”