Carpal tunnel syndrome in acromegaly: a nationwide study

in European Journal of Endocrinology
View More View Less
  • 1 Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
  • 2 Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
  • 3 Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  • 4 Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
  • 5 PharmaLex, Gothenburg, Sweden

Correspondence should be addressed to K Vouzouneraki; Email: konstantina.vouzouneraki@umu.se
Restricted access

Objective

Carpal tunnel syndrome (CTS) is common in patients with acromegaly, with a reported prevalence of 19–64%. We studied CTS in a large national cohort of patients with acromegaly and the temporal relationship between the two diagnoses.

Design

Retrospective, nationwide, cohort study including patients diagnosed with acromegaly in Sweden, 2005–2017, identified in the Swedish Healthcare Registries.

Methods

CTS (diagnosis and surgery in specialised healthcare) was analysed from 8.5 years before the diagnosis of acromegaly until death or end of the study. Standardised incidence ratios (SIRs) with 95% CIs were calculated for CTS with the Swedish population as reference.

Results

The analysis included 556 patients with acromegaly (50% women) diagnosed at mean (s.d.) age 50.1 (15.0) years. During the study period, 48 patients were diagnosed with CTS and 41 patients underwent at least one CTS surgery. In the latter group, 35 (85%) were operated for CTS before the acromegaly diagnosis; mean interval (range) 2.2 (0.3–8.5) years and the SIR for having CTS surgery before the diagnosis of acromegaly was 6.6 (4.8–8.9). Women with acromegaly had a higher risk for CTS than men (hazard ratio: 2.5, 95% CI: 1.3–4.7).

Conclusions

Patients with acromegaly had a 6-fold higher incidence for CTS surgery before the diagnosis of acromegaly compared with the general population. The majority of patients with both diagnoses were diagnosed with CTS prior to acromegaly. Increased awareness of signs of acromegaly in patients with CTS might help to shorten the diagnostic delay in acromegaly, especially in women.

 

     European Society of Endocrinology

Sept 2018 onwards Past Year Past 30 Days
Abstract Views 948 948 80
Full Text Views 156 156 6
PDF Downloads 83 83 11
  • 1

    Melmed S Acromegaly. New England Journal of Medicine 2006 355 25582573. (https://doi.org/10.1056/NEJMra062453)

  • 2

    Dal J, Feldt-Rasmussen U, Andersen M, Kristensen , Laurberg P, Pedersen L, Dekkers OM, Sørensen HT & Jørgensen JO Acromegaly incidence, prevalence, complications and long-term prognosis: a nationwide cohort study. European Journal of Endocrinology 2016 175 181190. (https://doi.org/10.1530/EJE-16-0117)

    • Search Google Scholar
    • Export Citation
  • 3

    Colao A, Ferone D, Marzullo P & Lombardi G Systemic complications of acromegaly: epidemiology, pathogenesis, and management. Endocrine Reviews 2004 25 102152. (https://doi.org/10.1210/er.2002-0022)

    • Search Google Scholar
    • Export Citation
  • 4

    Katznelson L, Laws Jr ER, Melmed S, Molitch ME, Murad MH, Utz A, Wass JAEndocrine Society. Acromegaly: an endocrine society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism 2014 99 39333951. (https://doi.org/10.1210/jc.2014-2700)

    • Search Google Scholar
    • Export Citation
  • 5

    Lesén E, Granfeldt D, Houchard A, Dinet J, Berthon A, Olsson DS, Björholt I & Johannsson G Comorbidities, treatment patterns and cost-of-illness of acromegaly in Sweden: a register-linkage population-based study. European Journal of Endocrinology 2017 176 203212. (https://doi.org/10.1530/EJE-16-0623)

    • Search Google Scholar
    • Export Citation
  • 6

    Vouzouneraki K, Franklin KA, Forsgren M, Wärn M, Persson JT, Wik H, Dahlgren C, Nilsson AS, Alkebro C & Burman P et al. Temporal relationship of sleep apnea and acromegaly: a nationwide study. Endocrine 2018 62 456463. (https://doi.org/10.1007/s12020-018-1694-1)

    • Search Google Scholar
    • Export Citation
  • 7

    Esposito D, Ragnarsson O, Granfeldt D, Marlow T, Johannsson G & Olsson DS Decreasing mortality and changes in treatment patterns in patients with acromegaly from a nationwide study. European Journal of Endocrinology 2018 178 459469. (https://doi.org/10.1530/EJE-18-0015)

    • Search Google Scholar
    • Export Citation
  • 8

    Ritvonen E, Löyttyniemi E, Jaatinen P, Ebeling T, Moilanen L, Nuutila P, Kauppinen-Mäkelin R & Schalin-Jäntti C Mortality in acromegaly: a 20-year follow-up study. Endocrine-Related Cancer 2016 23 469480. (https://doi.org/10.1530/ERC-16-0106)

    • Search Google Scholar
    • Export Citation
  • 9

    Keskin FE, Yetkin DO, Ozkaya HM, Haliloglu O, Sadri S, Gazioglu N, Tanrıover N, Ak H, Hatipoglu E & Kadıoglu P The problem of unrecognized acromegaly: surgeries patients undergo prior to diagnosis of acromegaly. Journal of Endocrinological Investigation 2015 38 695700. (https://doi.org/10.1007/s40618-015-0245-3)

    • Search Google Scholar
    • Export Citation
  • 10

    Siegel S, Streetz-van der Werf C, Schott JS, Nolte K, Karges W & Kreitschmann-Andermahr I Diagnostic delay is associated with psychosocial impairment in acromegaly. Pituitary 2013 16 507514. (https://doi.org/10.1007/s11102-012-0447-z)

    • Search Google Scholar
    • Export Citation
  • 11

    Holdaway IM, Rajasoorya RC & Gamble GD Factors influencing mortality in acromegaly. Journal of Clinical Endocrinology and Metabolism 2004 89 667674. (https://doi.org/10.1210/jc.2003-031199)

    • Search Google Scholar
    • Export Citation
  • 12

    Abreu A, Tovar AP, Castellanos R, Valenzuela A, Giraldo CM, Pinedo AC, Guerrero DP, Barrera CA, Franco HI & Ribeiro-Oliveira Jr A et al. Challenges in the diagnosis and management of acromegaly: a focus on comorbidities. Pituitary 2016 19 448457. (https://doi.org/10.1007/s11102-016-0725-2)

    • Search Google Scholar
    • Export Citation
  • 13

    Esposito D, Ragnarsson O, Johannsson G & Olsson DS Prolonged diagnostic delay in acromegaly is associated with increased morbidity and mortality. European Journal of Endocrinology 2020 182 523531. (https://doi.org/10.1530/EJE-20-0019)

    • Search Google Scholar
    • Export Citation
  • 14

    Giustina A, Barkan A, Beckers A, Biermasz N, Biller BMK, Boguszewski C, Bolanowski M, Bonert V, Bronstein MD & Casaneuva FF et al. A consensus on the diagnosis and treatment of acromegaly comorbidities: an update. Journal of Clinical Endocrinology and Metabolism 2020 105 dgz096. (https://doi.org/10.1210/clinem/dgz096)

    • Search Google Scholar
    • Export Citation
  • 15

    Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J & Rosén I Prevalence of carpal tunnel syndrome in a general population. JAMA 1999 282 153158. (https://doi.org/10.1001/jama.282.2.153)

    • Search Google Scholar
    • Export Citation
  • 16

    Padua L, Coraci D, Erra C, Pazzaglia C, Paolasso I, Loreti C, Caliandro P & Hobson-Webb LD Carpal tunnel syndrome: clinical features, diagnosis, and management. Lancet Neurology 2016 15 12731284. (https://doi.org/10.1016/S1474-4422(1630231-9)

    • Search Google Scholar
    • Export Citation
  • 17

    Küçükakkaş O & Yurdakul OV The diagnostic value of clinical examinations when diagnosing carpal tunnel syndrome assisted by nerve conduction studies. Journal of Clinical Neuroscience 2019 61 136141. (https://doi.org/10.1016/j.jocn.2018.10.106)

    • Search Google Scholar
    • Export Citation
  • 18

    Duckworth AD, Jenkins PJ & McEachan JE Diagnosing carpal tunnel syndrome. Journal of Hand Surgery 2014 39 14031407. (https://doi.org/10.1016/j.jhsa.2014.03.039)

    • Search Google Scholar
    • Export Citation
  • 19

    Baum H, Lüdecke DK & Herrmann HD Carpal tunnel syndrome and acromegaly. Acta Neurochirurgica 1986 83 5455. (https://doi.org/10.1007/BF01420508)

    • Search Google Scholar
    • Export Citation
  • 20

    Kameyama S, Tanaka R, Hasegawa A, Tamura T & Kuroki M Subclinical carpal tunnel syndrome in acromegaly. Neurologia Medico-Chirurgica 1993 33 547551. (https://doi.org/10.2176/nmc.33.547)

    • Search Google Scholar
    • Export Citation
  • 21

    Miller A, Doll H, David J & Wass J Impact of musculoskeletal disease on quality of life in long-standing acromegaly. European Journal of Endocrinology 2008 158 587593. (https://doi.org/10.1530/EJE-07-0838)

    • Search Google Scholar
    • Export Citation
  • 22

    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 695700. (https://doi.org/10.1007/s11102-015-0642-9)

    • Search Google Scholar
    • Export Citation
  • 23

    Mestron A, Webb SM, Astorga R, Benito P, Catala M, Gaztambide S, Gomez JM, Halperin I, Lucas-Morante T & Moreno B et al. Epidemiology, clinical characteristics, outcome, morbidity and mortality in acromegaly based on the Spanish Acromegaly Registry (Registro Espanol de Acromegalia, REA). European Journal of Endocrinology 2004 151 439446. (https://doi.org/10.1530/eje.0.1510439)

    • Search Google Scholar
    • Export Citation
  • 24

    Oktayoglu P, Nas K, Kilinç F, Tasdemir N, Bozkurt M & Yildiz I Assessment of the presence of carpal tunnel syndrome in patients with diabetes mellitus, hypothyroidism and acromegaly. Journal of Clinical and Diagnostic Research 2015 9 OC14OC 18. (https://doi.org/10.7860/JCDR/2015/13149.6101)

    • Search Google Scholar
    • Export Citation
  • 25

    Tagliafico A, Resmini E, Nizzo R, Bianchi F, Minuto F, Ferone D & Martinoli C Ultrasound measurement of median and ulnar nerve cross-sectional area in acromegaly. Journal of Clinical Endocrinology and Metabolism 2008 93 905909. (https://doi.org/10.1210/jc.2007-1719)

    • Search Google Scholar
    • Export Citation
  • 26

    Ludvigsson JF, Andersson E, Ekbom A, Feychting M, Kim JL, Reuterwall C, Heurgren M & Olausson PO External review and validation of the Swedish national inpatient register. BMC Public Health 2011 11 450. (https://doi.org/10.1186/1471-2458-11-450)

    • Search Google Scholar
    • Export Citation
  • 27

    Wettermark B, Hammar N, MichaelFored C, Leimanis A, Otterblad Olausson P, Bergman U, Persson I, Sundström A, Westerholm B & Rosén M The new Swedish Prescribed Drug Register: opportunities for pharmacoepidemiological research and experience from the first six months. Pharmacoepidemiology and Drug Safety 2007 16 726735. (https://doi.org/10.1002/pds.1294)

    • Search Google Scholar
    • Export Citation
  • 28

    Socialstyrelsen. Klassifikation av Vårdåtgärder (KVÅ). Stockholm: Socialstyrelsen, 2018. (available at: https://www.socialstyrelsen.se/utveckla-verksamhet/e-halsa/klassificering-och-koder/kva/). Accessed on 30 Apr 2020.

    • Search Google Scholar
    • Export Citation
  • 29

    Caron P, Brue T, Raverot G, Tabarin A, Cailleux A, Delemer B, Renoult PP, Houchard A, Elaraki F & Chanson P Signs and symptoms of acromegaly at diagnosis: the physician’s and the patient’s perspectives in the ACRO-POLIS Study. Endocrine 2019 63 120129. (https://doi.org/10.1007/s12020-018-1764-4)

    • Search Google Scholar
    • Export Citation
  • 30

    Resmini E, Tagliafico A, Nizzo R, Bianchi F, Minuto F, Derchi L, Marinoli C & Ferone D Ultrasound of peripheral nerves in acromegaly: changes at 1-year follow-up. Clinical Endocrinology 2009 71 220225. (https://doi.org/10.1111/j.1365-2265.2008.03468.x)

    • Search Google Scholar
    • Export Citation
  • 31

    Atroshi I, Englund M, Turkiewicz A, Tägil M & Petersson IF Incidence of physician-diagnosed carpal tunnel syndrome in the general population. Archives of Internal Medicine 2011 171 943944. (https://doi.org/10.1001/archinternmed.2011.203)

    • Search Google Scholar
    • Export Citation
  • 32

    Pourmemari MH & Shiri R Diabetes as a risk factor for carpal tunnel syndrome: a systematic review and meta-analysis. Diabetic Medicine 2016 33 1016. (https://doi.org/10.1111/dme.12855)

    • Search Google Scholar
    • Export Citation
  • 33

    Tseng C-H, Liao C-C, Kuo C-M, Sung F-C, Hsieh DPH & Tsai C-H Medical and non-medical correlates of carpal tunnel syndrome in a Taiwan cohort of one million. European Journal of Neurology 2012 19 9197. (https://doi.org/10.1111/j.1468-1331.2011.03440.x)

    • Search Google Scholar
    • Export Citation
  • 34

    Lakshminarayanan K, Shah R & Li ZM Sex-related differences in carpal arch morphology. PLoS ONE 2019 14 e0217425. (https://doi.org/10.1371/journal.pone.0217425)

    • Search Google Scholar
    • Export Citation
  • 35

    Al-Rousan T, Sparks JA & Pettinger M et al. Menopausal hormone therapy and the incidence of carpal tunnel syndrome in postmenopausal women: findings from the Women’s Health Initiative. PLoS ONE 2018 13 e0207509. (https://doi.org/10.1371/journal.pone.0207509)

    • Search Google Scholar
    • Export Citation
  • 36

    Alibas H, Gogas Yavuz D, Kahraman Koytak P, Uygur M, Tanridag T & Uluc K Peripheral nervous system assessment in acromegaly patients under somatostatin analogue therapy. Journal of Endocrinological Investigation 2017 40 3340. (https://doi.org/10.1007/s40618-016-0522-9)

    • Search Google Scholar
    • Export Citation
  • 37

    Reid TJ, Post KD, Bruce JN, Nabi Kanibir M, Reyes-Vidal CM & Freda PU Features at diagnosis of 324 patients with acromegaly did not change from 1981 to 2006: acromegaly remains under-recognized and under-diagnosed. Clinical Endocrinology 2010 72 203208. (https://doi.org/10.1111/j.1365-2265.2009.03626.x)

    • Search Google Scholar
    • Export Citation
  • 38

    Danilowicz K, Fainstein Day P, Manavela MP, Herrera CJ, Deheza ML, Isaac G, Juri A, Katz D & Bruno OD Implementing a screening program for acromegaly in Latin America: necessity versus feasibility. Pituitary 2016 19 370374. (https://doi.org/10.1007/s11102-016-0714-5)

    • Search Google Scholar
    • Export Citation
  • 39

    Boguszewski CL Acromegaly: ‘you must know it to think of it’. European Journal of Endocrinology 2020 183 C1C4. (https://doi.org/10.1530/EJE-20-0281)

    • Search Google Scholar
    • Export Citation
  • 40

    Lenders NF, McCormack AI & Ho KKY Management of endocrine disease. Does gender matter in the management of acromegaly? European Journal of Endocrinology 2020 182 R67R 82. (https://doi.org/10.1530/EJE-19-1023)

    • Search Google Scholar
    • Export Citation
  • 41

    Zoicas F, Kleindienst A, Mayr B, Buchfelder M, Megele R & Schöfl C Screening for acromegaly in patients with carpal tunnel syndrome: a prospective study (ACROCARP). Hormone and Metabolic Research 2016 48 452456. (https://doi.org/10.1055/s-0042-100913)

    • Search Google Scholar
    • Export Citation
  • 42

    Prencipe N, Floriani I, Guaraldi F, Di Giacomo SV, Cannavo S, Arnaldi G, Berton A, Torri V, Spinello M & Arvat E et al. ACROSCORE: a new and simple tool for the diagnosis of acromegaly, a rare and underdiagnosed disease. Clinical Endocrinology 2016 84 380385. (https://doi.org/10.1111/cen.12959)

    • Search Google Scholar
    • Export Citation