Abstract
Early diagnosis of acromegaly prevents irreversible comorbidities and facilitates
surgical cure. Carpal tunnel syndrome (CTS) is common in acromegaly and patients have
often undergone surgery for CTS prior to the diagnosis of acromegaly. We hypothesized
that screening CTS-patients for acromegaly could facilitate active case-finding. We
prospectively enrolled 196 patients [135 women, 56.9 (range 23–103) years] who presented
with CTS for surgery. Patients were asked about 6 symptoms suggestive of acromegaly
using a questionnaire calculating a symptom score (0–6 points), and insulin-like-growth
factor 1 (IGF-1) was measured. If IGF-1 was increased, IGF-1 measurement was repeated,
and random growth hormone (GH) and/or an oral glucose tolerance test (OGTT) with assessment
of GH-suppression were performed. The mean symptom score was 1.7±1.3 points. Three
patients reported the maximal symptom score of 6 points, but none of them had an increased
IGF-1. There was no correlation between the symptom score and IGF-1-SDS (standard
deviation score) (r=0.026; p=0.71). Four patients had an IGF-1>2 SDS. In 2 patients
acromegaly was ruled out using random GH and OGTT. One patient had normal IGF-1 and
random GH at follow-up. One patient refused further diagnostics. In this prospective
cohort of patients with CTS, the observed frequency of acromegaly was at most 0.51%
(95% CI 0.03 to 2.83%). In this prospective study, none of the 196 patients with CTS
had proven acromegaly. Thus, we see no evidence to justify general screening of patients
with CTS for acromegaly.
Key words
acromegaly - carpal tunnel syndrome - screening - IGF-1 - growth hormone - pituitary
