Carpal tunnel syndrome in acromegaly is also related to median nerve oedema
BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1701 (Published 30 April 2020) Cite this as: BMJ 2020;369:m1701
- Philippe Chanson, professor of endocrinology
- Service d’Endocrinologie et des Maladies de la Reproduction, Hôpital Bicêtre, 94275 Le Kremlin-Bicêtre, France
- philippe.chanson{at}aphp.fr
Lake and Chaidarun provide images of spade phalanx signs typical of acromegaly.1 In the text accompanying these images, they elaborate on acromegalic arthropathy and claim that carpal tunnel syndrome in acromegaly is another sign of arthropathy, “related to synovial oedema, which leads to median nerve compression.”
Carpal tunnel syndrome is also (and maybe more importantly) related to oedema of the median nerve itself, as elegantly demonstrated 20 years ago by Jenkins et al, who used magnetic resonance imaging to measure the cross sectional area of the median nerve.2 This was confirmed by ultrasonographic studies showing that acromegaly was associated with oedema of not only the median nerve but also the ulnar nerve.3 Patients with active acromegaly have generalised visceral oedema related to the effect of growth hormone on the distal kidney, where it enhances epithelial sodium channel activity and stimulates sodium reabsorption.4
Footnotes
Competing interests: None declared.