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DOI: 10.1055/s-0035-1547666
Acromegaly in patients with carpal tunnel syndrome: A prospective study (ACROCARP)
Introduction: Diagnosis of acromegaly is often delayed by 5 – 10 years. Early diagnosis prevents the development of irreversible comorbidities and facilitates surgical cure. Carpal tunnel syndrome (CTS) is common in acromegaly and patients often had surgery for CTS several years before the diagnosis of acromegaly was made. We therefore hypothesized that CTS, which causes a high degree of suffering, could be a suitable screening parameter for active case-finding in order to accelerate the diagnosis of acromegaly.
Objectives:
To investigate the frequency of acromegaly in CTS patients
Patients and methods:
We prospectively enrolled 196 consecutive patients (mean age 61.5 years, 135 women, 61 men) who presented with one- (94) or both-sided (102) CTS for surgery in a regional referral center within a period of 18 months. Patients were asked for symptoms suggestive for acromegaly (sweating, headache, arthralgia, snoring, increase in ring or shoe size) by questionnaire calculating a symptoms score (0 – 6 points), and IGF-1 was measured. If IGF-1 was increased for sex and age, random GH and/or an oral glucose tolerance test (OGTT) with assessment of GH-suppression was performed. The study was approved by the local ethics committee and all patients gave written informed consent.
Results:
The mean symptoms score was 2 ± 1 points. Three patients reported the maximal symptoms score of 6 points, but none of them had an increased IGF-1. Three patients with moderate symptoms scores of 2.7 ± 0.3 points had an IGF-1 ≥2 SDS. None of these patients, however, had acromegaly according to random GH or OGTT (GH min < 0.05 ng/ml). Thus, the frequency of acromegaly in this cohort was < 0.5%.
Conclusion:
In this prospective study in a regional referral center for CTS-surgery none of the 196 patients presenting with one- or both-sided CTS had acromegaly. Thus, general screening of patients with CTS to diagnose acromegaly early does not seem to be warranted.