Subclinical Carpal Tunnel Syndrome in Acromegaly

Abstract

Median nerve conduction was studied in 16 acromegalic patients with asymptomatic carpal tunnel syn drome (CTS) to examine the incidence of subclinical CTS. Thirteen patients (81%) and 23 hands (72%) demonstrated subclinical CTS, 10 bilaterally and three unilaterally in the dominant hand. The incidence reflects the greater sensitivity of the inching method for detecting focal conduction abnormalities.Two of three patients without subclinical CTS showed normal plasma somatomedin C concentration despite growth hormone hypersecretion. Following adenomectomy, nerve conduc tion normalized in only six hands (26%). The postoperative persistence of the conduction delay im plies that irreversible narrowing of the carpal tunnel rather than reversible soft tissue edema is the principal cause of CTS associated with acromegaly.

Musculoskeletal complications of acromegaly: what radiologists should know about early manifestations

“…L'associazione tra acromegalia e sindrome del tunnel carpale è stata riconosciuta come una frequente complicanza della malattia con una prevalenza che può raggiungere il 64% al momento della diagnosi [2,3,8,10]. Inoltre, nella maggioranza dei pazienti ci sono anomalie subcliniche a livello di conduzione nervosa [9][10][11][12][13][14][15][16]. Alcuni autori hanno riferito che la sindrome del tunnel carpale potrebbe essere causata da un aumento dell'edema all'interno del nervo mediano…”

“…piuttosto che da una compressione estrinseca all'interno del tunnel [13]. Altri studi invece sostengono che la sindrome del tunnel carpale sia causata da tessuto sinoviale o da un restringimento irreversibile del tunnel carpale [12,[14][15][16].…”

“…Association with acromegaly and median neuropathy or carpal tunnel syndrome is recognised as a common condition of this disease, with a prevalence up to 64% of patients at presentation [2,3,8,10], and nerve conduction studies reported subclinical abnormalities in the vast majority of patients [9][10][11][12][13][14][15][16]. Moreover, some authors have reported that the development of a carpal tunnel syndrome is probably due to oedema of the median nerve within the carpal tunnel rather than extrinsic compression from increased volume of the carpal tunnel …”

“…Other studies, on the contrary, have reported that carpal tunnel syndrome in acromegaly is due either to oedematous synovial tissues that compresses the median nerve or to irreversible narrowing of the carpal tunnel [12,[14][15][16].…”

Medical consequences of acromegaly: What are the effects of biochemical control?

“…Another common condition in acromegaly is symptomatic carpal tunnel syndrome, with a prevalence from 20-64% of the patients at presentation. Nerve conduction studies have documented subclinical abnormalities in the vast majority of patients [92]. The predominant pathology of median neuropathy in acromegaly consists of increased edema of the median nerve in the carpal tunnel, rather than extrinsic compression due to increased volume of the carpal tunnel contents [93].…”