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Surgery Not Recommended for Acromegalic Carpal Tunnel Syndrome
Source: Jenkins PJ, et al. The pathology of median neuropathy in acromegaly. Ann Intern Med 2000;133:197-201.
Nine acromegalic patients underwent mag-netic resonance imaging (MRI) of the carpal tunnel to determine the pathology of acromegalic median neuropathy. Patients were studied at the time of presentation of acromegaly and six months following therapy, encompassing pituitary surgery, pituitary irradiation, and/or somatostatin analogues. Diagnosis of acromegaly was based on standard criteria and elevated serum growth hormone. Four patients had clinical and electrodiagnostically confirmed carpal tunnel syndrome (CTS), five did not and were electrodiagnostically normal. MRI measurements, performed in a blinded manner by two radiologists on three separate readings, included median nerve cross-sectional area and signal intensity, and degree of upward bowing of the carpal ligament as an indirect indication of carpal tunnel volume. Statistical analysis used the Mann-Whitney U test and the Wilcoxon signed-rank test.
Patients with clinical CTS demonstrated significantly increased median nerve cross-sectional area (P = 0.014), and a non-significant (P = 0.068) trend toward enhanced signal intensity on MRI compared to those without CTS. Carpal tunnel volume did not differ between the two groups (P > 0.2). Following treatment of acromegaly, cross-sectional area and signal intensity improved in the CTS symptomatic group, with resolution of CTS symptoms and improved electrodiagnostic parameters, whereas these worsened or remained unchanged in the asymptomatic, non-CTS, group. Edematous swelling rather than extrinsic compression is the cause of acromegalic CTS, and surgery should be directed at the pituitary gland rather than at the carpal ligament. Following treatment of acromegaly, CTS will resolve. —Michael Rubin
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