Carpal tunnel syndrome (CTS) is neuropathy that occurs due to compression of the median nerve in the carpal tunnel. Acromegaly is one of the important causes of CTS. The aim of this study was to examine median nerve with ultrasound in acromegalic patients and to assess the relationship with activity, duration of disease and body composition parameters. We prospectively examined the cross-sectional area (CSA) of the median nerve with high-resolution ultrasound in 107 acromegalic patients (70 females and 37 males) and 107 healthy controls (70 females and 37 males) matched for age, gender, and BMI. Body composition parameters were assessed by dual-energy X-ray absorptiometry (DXA). The Student t-tests and Pearson correlation were used for data analysis. The cross sectional area of the median nerve was increased in acromegalic patients compared to controls (11.9 ± 4.8 mm2 vs. 7.7 ± 2.4 mm2, P < 0.001). Positive correlation was found between IGF-1 levels and CSA in the acromegalic group (R = 0.400, P < 0.001). Relationship between CSA and duration of acromegaly was not confirmed. In acromegalic patients, BMI correlated with the CSA (R = 0.294, P = 0.002). There was no significant difference in BMI, fat mass between the acromegalic and control group, but lean mass was higher in acromegalic patients compared with controls (54.8 ± 13.3 vs. 51 ± 11.6, P = 0.047). Lean mass and LMI (total body lean mass/height) positively correlated with CSA in acromegalic patients (R = 0.340, P < 0.001; R = 0.424, P < 0.001). No correlation was observed between fat mass and CSA of median nerve in all groups. We confirmed the enlargement of the median nerve in acromegalic patients. This enlargement is proportional to the degree of IGF-1 levels and is not dependent on the duration of the disease. The enlargement of the median nerve in acromegalic patients also depends on lean body mass and is not dependent on fat body mass.

Department of Endocrinology National Institute of Endocrinology and Diabetology Ľubochňa Slovakia

Zobrazit více v PubMed

AZAMI A, MALEKI N, ANARI H, IRANPARVAR MA, KALANTARHORMOZI M, TAVOSI Z. The diagnostic value of ultrasound compared with nerve conductionvelocity in carpla tunnel syndrome. Int J Rheum Dis. 2014;17:612–620. doi: 10.1111/1756-185x.12310. PubMed DOI

BEEKMAN R, VISSER L. Sonography in the diagnosis of carpal tunnel syndrome a critical review of the literature. Muscle Nerve. 2003;27:26–33. doi: 10.1002/mus.10227. PubMed DOI

BRUMBACK RA, BARR CE. Myopathy in acromegaly. A case study. Pathol Res Pract. 1983;177:41–46. PubMed

COLAO A, FERONE D, MARZULLO P, LOMBARDI G. Systemic complications of acromegaly: epidemiology, pathogenesis and management. Endocr Rev. 2004;25:102–152. doi: 10.1210/er.2002-0022. PubMed DOI

DALILI AR, MARDANI KM, ALIZADEH A, HATAMIAN HR, HOSEININEJAD N, PEYRAZM H. Comparison between sonography and electrodiagnostic testing in the diagnosis of carpal tunnel syndrome. Anesthesiol Pain. 2011;2:43–51.

FREDA PU, SHEN W, REYES-VIDAL CM, GEER EB, ARIAS-MENDOZA F, GALLAGHER D, HEYMSFIELD SB. Skeletal muscle mass in acromegaly assessed by magnetic resonance imaging and dual-photon x-ray absorptiometry. J Clin Endocrinol Metab. 2009;94:2880–2886. doi: 10.1210/jc.2009-0026. PubMed DOI PMC

FU T, CAO M, LIU F, ZHU J, YE D, FENG X, XU Y, WANG G, BAI Y. Carpal tunnel syndrome assesment with ultrasonography: value of inlet-to-outlet median nerve arearation in patients versus healthy volunteers. Plos one. 2015;10:e0116777. doi: 10.1371/journal.pone.0116777. PubMed DOI PMC

FŰCHTBAUER L, OLSSON DS, BENGTSSON BÅ, NORRMAN LL, SUNNERHAGEN KS, JOHANNSSON G. Muscle strength in patients with acromegaly at diagnosis and during long-term follow-up. Eur J Endocrinol. 2017;177:217–226. doi: 10.1530/eje-17-0120. PubMed DOI

GHASEMI-ESFE A, KHALILZADEH O, MAZLOUMI M, VAZIRI-BOZORG SM, KAHNOUJI H, RAHMANI M. Combination of high-resolution and color Doppler ultrasound in diagnosis of carpal tunnel syndrome. Acta Radiol. 2011;52:191–197. doi: 10.1258/ar.2010.100299. PubMed DOI

GIBNEY J, WOLTHERS T, BURT MG, LEUNG KC, UMPLEBY AM, HO KK. Protein metabolism in acromegaly: differential effects of short- and long-term treatment. J Clin Endocrinol Metab. 2007;92:1479–1484. doi: 10.1210/jc.2006-0664. PubMed DOI

GIUSTINA A, BARKAN A, CASANUEVA FF, CAVAGNINI F, FROHMAN L, HO K, VELDHUIS J, WASS J, Von WERDER K, MELMED S. Criteria for cure of acromegaly: a consensus statement. J Clin Endocrinol Metab. 2000;85:526–529. doi: 10.1210/jcem.85.2.6363. PubMed DOI

HOLOVÁČOVÁ D, KUŽMA M, KOLLINGER Z, PAYER J. Cross sectional area of th median nerve is increased in primary autoimmune hypothyroidism and decrease upon treatment with thyroxine. Eur J Endocrinol. 2016;175:265–270. doi: 10.1530/eje-16-0397. PubMed DOI

JABLECKI CK, ANDARY MT, SO YT, WILKINS DE, WILLIAMS FH. Literature review of the usefulness of nerve conduction studies and electromyography for the evaluation of patients with carpal tunnel syndrome. AAEM Quality Assurance Committee. Muscle Nerve. 1993;16:1392–1414. doi: 10.1002/mus.880161220. PubMed DOI

JENKINS PJ, SOHAIB SA, AKKER S, PHILLIPS RR, SPILLANE K, WASS JA, MONSON JP, GROSSMAN AB, BESSER GM, REZNEK RH. The pathology of median neuropathy in acromegaly. Ann Intern Med. 2000;133:197–201. doi: 10.7326/0003-4819-133-3-200008010-00011. PubMed DOI

KAJI H, SUGIMOTO T, NAKAOKA D, OKIMURA Y, KAJI H, ABE H, CHIHARA K. Bone metabolism and body composition in Japanese patients with active acromegaly. Clin Endocrinol (Oxf) 2001;55:175–181. doi: 10.1046/j.1365-2265.2001.01280.x. PubMed DOI

KAMENICKÝ P, MAZZIOTTI G, LOMBES M, GIUSTINA A, CHANSON P. Growth hormone, insulin–like growth factor -1, and the kidney: pathophysiological and clinical implications. Endocr Rev. 2014;35:234–281. doi: 10.1210/er.2013-1071. PubMed DOI

KANEYAMA S, TANAKA R, HASEGAWA A, TAMURA T, KUROKI M. Subclinical carpal tunnel syndrome in acromegaly. Neurol Med Chir. 1993;3:547–551. doi: 10.2176/nmc.33.547. PubMed DOI

KATZNELSON L. Alterations in body composition in acromegaly. Pituitary. 2009;12:136–142. doi: 10.1007/s11102-008-0104-8. PubMed DOI

KILLINGER Z, PAYER J, LAZÚROVÁ I, IMRICH R, HOMÉROVÁ Z, KUŽMA M, ROVENSKÝ J. Arthropathy in acromegaly. Rheum Dis Clin North Am. 2010;36:713–720. doi: 10.1016/j.rdc.2010.09.004. PubMed DOI

KIM J, KIM M, KO Y. Correlating ultrasound findings of carpal tunnel syndrome with nerve conduction studies. Muscle Nerve. 2013;48:905–910. doi: 10.1002/mus.23841. PubMed DOI

KOCAK M, CIVAN N, KARKUCAK M, CAPKIN E, GARIPOGLU M, CAN I, KARACA A, TASDELEN M, AYAR A. Ultrasonographic assessment of soft tissues in patients with acromegaly. Arch Rheumatol. 2015;30:138–143. doi: 10.5606/archrheumatol.2015.5158. DOI

LAKE J, CHAIDURUN S. Spade phalanx sign of acromegaly. BMJ. 2020;368 doi: 10.1136/bmj.m691. DOI

LANDIN K, PETRUSON B, JAKOBSSON KE, BENGTSOON BA. Skeletal muscle sodium and potassium changes after successful surgery in acromegaly: relation to body composition, blood glucose, plasma insulin and blood pressure. Acta Endocrinol (Copenh) 1993;128:418–422. doi: 10.1530/acta.0.1280418. PubMed DOI

LUGO G, PENA L, CORDIDO F. Clinical manifestation and diagnosis of acromegaly. Int J Endocrinol. 2012 doi: 10.1155/2012/540398. Article ID 540398. PubMed DOI PMC

MADSEN M, KRUSENSTJERNA-HAFSTROM T, MOLLER L, CHRISTENSEN B, VENDELBO MH, PEDERSEN SB, FRYSTYK J, JESSEN N, HANSEN TK, JORGENSEN HS, FLYVBERG A, JORGENSEN JO. Fat content in liver and skeletal muscle changes in a reciprocal manner in patients with acromegaly during combination therapy with a somatostatin analog and a GH receptor antagonist: a randomized clinical trial. J Clin Endocrinol Metab. 2012;97:1227–1235. doi: 10.1210/jc.2011-2681. PubMed DOI

McDONAGH C, ALEXANDER M, KANE D. The role of ultrasound in the diagnosis and management of carpal tunnel syndrome: a new paradigm. Rheumatology. 2015;54:19–24. doi: 10.1093/rheumatology/keu275. PubMed DOI

MILNER A. Acromegaly and gigantism. S Afr Med J. 2018;24:62–66.

MOHAMMADI A, AFSHAR A, ETEMADI A, MASOUDI S, BAGHIZADEH A. Diagnostic value of cross-sectional area of the median nerve in grading severity of carpal tunnel syndrome. Arch Iran Med. 2010;13:516–521. PubMed

MOLLER J. Effects of growth hormone on fluid homeostasis. Clinical and experimental aspects. Growth Horm IGF Res. 2003;13:55–74. doi: 10.1016/s1096-6374(03)00011-x. PubMed DOI

MONDELLI M, FARIOLI A, MATTIOLI S, ARETINI A, GIAŃANNESCHI F, GRECO G, CURTI S. Associations between body anthropometric measures and severity of carpal tunnel syndrome. Arch Phys Med Rehabil. 2016;9:1456–1464. doi: 10.1016/j.apmr.2016.03.028. PubMed DOI

OKTAYOGLU P, NAS K, KILINC F, TASDEMIR N, BOZKURT M, YILDIZ I. Assessment of the presence of carpal tunnel syndrome in patients with diabetes mellitus, hypothyroidism and acromegaly. J Clin Diagnostic Res. 2015;9:14–18. doi: 10.7860/jcdr/2015/13149.6101. PubMed DOI PMC

PAYAM S, MAHROOZ M, GHAJARZADEH M, MIRI S, PARHIZGAR E, EMAMI-RAZAVI SH. The best cutoff point for median nerve cross sectional area at the level of carpal tunnel inlet. Acta Medica Iranica. 2014;52:613–618. PubMed

PINILLA I, MARTIN-HERVAS C, SORD G, SANTIAGO S. The usefulness of ulrasonography in the diagnosis of carpal tunnel syndrome. J Hand Surg Eur. 2008;33:43–59. PubMed

PIRLICH M, SCHUTZ T, OCKENGA J, BIERING H, SCHMIDT B, ERTL S, PLAUTH M, LOCHS H. Improved assessment of body cell mass by segmental bioimpedance analysis in malnourished subjects and acromegaly. Clin Nutr. 2003;22:167–174. doi: 10.1016/j.clnu.2004.01.002. PubMed DOI

REID TJ, JIN Z, SHEN W, REYES-VIDAL CM, FERNANDEZ JC, BRUCE JN, POST KD, FREDA PU. IGF-1 levels across the spectrum of normal to elevated in acromegaly: relationship to insulin sensitivity, markers of cardiovascular risk and body composition. Pituitary. 2015;18:808–819. doi: 10.1007/s11102-015-0657-2. PubMed DOI PMC

RESMINI E, TAGLIAFICO A, NIZZO R, BIANCHI F, MINUTO F, DERCHI L, MARTINOLI C, FERONE D. Ultrasound of peripheral nerves in acromegaly: changes at 1-year follow-up. Clin Endocrinol (Oxf) 2009;71:220–225. doi: 10.1111/j.1365-2265.2008.03468.x. PubMed DOI

SASAGAWA Y, TACHIBANA O, DOAI M, TONAMI H, IIZUKA H. Median nerve conduction studies and wrist magnetic resonance imaging in acromegalic patients with carpal tunnel syndrome. Pituitary. 2015;18:695–700. doi: 10.1007/s11102-015-0642-9. PubMed DOI

SHARIFI MA, YAZDCHI MM, AYRAMLOU H, HEIDARI P, SALAVATI A, ZARRINTAN S. Assessment of body mass index and hand anthropometric measurements as independent risk factors for carpal tunnel syndrome. Folia Morphol (Warsz) 2008;67:36–42. PubMed

SHIRI R, POURMEMARI MH, FALAH-HASSANI K, VIIKARI-JUNTURA E. The effect of excess body mass on the risk of carpal tunnel syndrome: a meta-analysis of 58 studies. Obes Rev. 2015;16:1094–1104. doi: 10.1111/obr.12324. PubMed DOI

TAGLIAFICO A, RESMINI E, NIZOO R, BIANCHI F, MINUTO F, FERONE D, MARTINOLI C. Ultrasound measurement of median and ulnar nerve cross-sectional area in acromegaly. J Clin Endocrinol Metab. 2008;93:905–909. doi: 10.1210/jc.2007-1719. PubMed DOI

TAGLIAFICO A, RUBINO M, AUTOURI A, BIANCHI S, MARTINOLI C. Wrist and hand ultrasound. Seminars in Musculoskeletal. Radiology. 2007;11:95–104. doi: 10.1055/s-2007-1001875. PubMed DOI

VELLOSO CP. Regulation of muscle mass by growth hormone and IGF-I. Br J Pharmacol. 2008;154:557–568. PubMed PMC

VIRAL CH, HO K. Action of GH on skeletal muscle function: molecular and metabolic mechanisms. J Mol Endocrinol. 2013;52:107–123. PubMed

WATANABE T, ITO H, SEKINE A, KATANO Y, NISHIMURA, KATO Y, TAKEDA J, SEISHIMA M, MTSUOKA T. Sonographic evaluation of the peripheral nerve in diabetic patients: the relationship between nerve conduction studies, echo intensity and cross-sectional area. J Ultrasound Med. 2010;29:697–708. doi: 10.7863/jum.2010.29.5.697. PubMed DOI

WERNER R. Electrodiagnostic evaluation of carpal tunnel syndrome and ulnar neuropathy. PM R. 2013;5:S14–S21. doi: 10.1016/j.pmrj.2013.03.027. PubMed DOI

XIAO B, LIU F, LU JCH, CEN F, PEI WN, YANG XCH. IGF-1 deletion affects renal sympathetic nerve activity, left ventricular dysfunction, and renal function in DOCA-salt hypertensive mice. Physiol Res. 2019;68:209–217. doi: 10.33549/physiolres.933918. PubMed DOI