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The Pathology of Median Neuropathy in Acromegaly

Paul J. Jenkins, MD, MRCP; S. Aslam Sohaib, MRCP, FRCR; Scott Akker, MRCP; Rachel R. Phillips, MRCP, FRCR; Kate Spillane, MRCP; John A.H. Wass, MD, FRCP; John P. Monson, MD, FRCP; Ashley B. Grossman, MD, FRCP; G. Michael Besser, MD, FRCP, DSc; and Rodney H. Reznek, FRCR, FRCP
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Copyright ©2004 by the American College of Physicians


Ann Intern Med. 2000;133(3):197-201. doi:10.7326/0003-4819-133-3-200008010-00011
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Background: Median neuropathy is commonly associated with acromegaly, although its pathology is uncertain.

Objective: To study the pathology of median neuropathy in acromegaly by using magnetic resonance imaging (MRI).

Design: Case series.

Setting: Outpatient clinic and MRI unit.

Patients: Nine patients with acromegaly, four of whom had clinical symptoms of neuropathy.

Measurements: At presentation and 6 months after treatment, median nerve size, its signal intensity, and the volume of the carpal tunnel contents were measured.

Results: At presentation, patients with symptoms of neuropathy had increased nerve size and signal intensity compared with asymptomatic patients, but the two groups did not differ in volume of carpal tunnel contents. These measures improved with treatment of acromegaly in symptomatic patients; asymptomatic patients experienced no change or worsening.

Conclusion: The predominant pathology of median neuropathy in acromegaly seems to be increased edema of the median nerve within the carpal tunnel rather than extrinsic compression from increased volume of the carpal tunnel contents.

Figures

Grahic Jump Location
Figure 1.
Cross-sectional diagram (top) and T2-weighted axial magnetic resonance imaging scan (bottom) of the wrist and carpal tunnel at the level of the hamate bone.
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Figure 2.
Findings in symptomatic and asymptomatic patients with acromegaly.Top.leftrightBottom left.Bottom right.P

Ratio of the cross-sectional area of the median nerve at the level of the pisiform ( ) and hamate ( ) bones. Signal intensity of the median nerve within the carpal tunnel. Values are expressed as a ratio compared to the intensity of surrounding fat. Degree of palmar bowing of the flexor retinaculum. Values, expressed as percentages, were calculated as the ratio of the distance from the flexor retinaculum to a perpendicular line from the hook of the hamate bone to the carpal bone. The data points are shown for individual patients at presentation and after 6 months. Median values are given in parentheses; values pertain to differences between these values.

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Summary for Patients

Carpal Tunnel Syndrome in Persons with Acromegaly

Copyright ©2004 by the American College of Physicians

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