Median nerve conduction studies and wrist magnetic resonance imaging in acromegalic patients with carpal tunnel syndrome

Sasagawa, Yasuo; Tachibana, Osamu; Doai, Mariko; Tonami, Hisao; Iizuka, Hideaki

doi:10.1007/s11102-015-0642-9

Cited by 14 publications

(19 citation statements)

References 18 publications

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“…For both median and ulnar nerves, disease control was associated with a reduction of the area values (p = 0.02 and p = 0.002, respectively) [64]. These results seem to be confirmed by recent studies involving magnetic resonance imaging in the study of carpal tunnel among ACRO [65].…”

Section: Musculoskeletal Complicationssupporting

confidence: 73%

Acromegaly and ultrasound: how, when and why?

Parolin

Dassiè

Vettor

et al. 2019

J Endocrinol Invest

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Background Acromegaly is a rare disease caused by an excess of growth hormone and insulin-like growth factor 1. It is usually diagnosed because of typical signs such as macroglossia, acral enlargement, jaw prognathism and malocclusion. Systemic complications are a major cause of morbidity and mortality in acromegaly, and many patients remain undiagnosed for several years. Increased ultrasound (US) application in the general population, and including among acromegaly patients, has revealed many suggestive features which, taken together with clinical suspicion, could induce suspicion of this disease. Purpose This review describes main US features in acromegaly. Echocardiography shows a typical cardiomyopathy, characterized by left ventricular hypertrophy, diastolic and systolic dysfunction, aortic and mitral regurgitation, and increased aortic root diameters. US preclinical markers of atherosclerosis, such as intima media thickness (IMT), seem also to be impaired. Visceromegaly and increased organ stiffness are other features of acromegaly, including enlarged prostate, kidneys, liver, and thyroid. In addition, other US findings are: renal cysts, micronephrolithiasis, impairment of renal haemodynamic parameters, gallstones and gallbladder polyps, hepatic steatosis, thyroid nodules, multinodular goiter, and polycystic ovaries. Musculoskeletal US findings are increased cartilage thickness, impaired density and elasticity of bones, nerve enlargement, carpal and cubital tunnel syndrome, and trigger finger. Conclusions Acromegaly patients frequently present systemic complications and a diagnostic delay. US features of acromegaly are not specific, but could potentially have a key role in early detection of the disease in the presence of typical clinical features.

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Section: Musculoskeletal Complicationssupporting

confidence: 73%

Acromegaly and ultrasound: how, when and why?

Parolin

Dassiè

Vettor

et al. 2019

J Endocrinol Invest

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“…Decompression of the carpal tunnel is the most common hand surgery with approximately 460 000 procedures per year in the US and 300 000 in Germany [24,25]. Symptomatic CTS occurs in up to 64 % of acromegaly patients [26][27][28][29][30][31] although only 6 % of acromegaly diagnoses are triggered by CTS [32]. Retrospective data, however, showed, that up to 20 % of patients underwent surgery for CTS years before acromegaly was diagnosed (unpublished results).…”

mentioning

confidence: 99%

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

et al. 2016

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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.

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“…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 .…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

mentioning

confidence: 99%

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

Burulday

Doğan

Şahan

et al. 2018

J of Ultrasound Medicine

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Median nerve conduction studies and wrist magnetic resonance imaging in acromegalic patients with carpal tunnel syndrome

Abstract: The median nerves of acromegalic patients with CTS were enlarged and had impaired nerve conduction. This finding represents a predominant intrinsic feature in the pathophysiology of the disease rather than an extrinsic feature such as a thickened transverse carpal ligament.

Cited by 14 publications

References 18 publications

Acromegaly and ultrasound: how, when and why?

Acromegaly and ultrasound: how, when and why?

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

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

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