The Pathology of Median Neuropathy in Acromegaly

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

From St. Bartholomew's Hospital, London, United Kingdom.

Abstract

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.

Article and Author Information

Acknowledgment: The authors thank Janice Thomas for expert assistance with statistical analysis.
Grant Support: In part by a research award from the Joint Research Board of St. Bartholomew's Hospital (Dr. Sohaib).
Requests for Single Reprints: Paul J. Jenkins, MD, MRCP, Department of Endocrinology, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, United Kingdom.
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Current Author Addresses: Drs. Jenkins, Akker, Monson, Grossman, and Besser: Department of Endocrinology, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, United Kingdom.
Drs. Sohaib and Reznek: Department of Radiology, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, United Kingdom.
Dr. Phillips: Department of Radiology, The Whittington Hospital, London N19 5NF, United Kingdom.
Dr. Spillane: Department of Neurophysiology, St. James' University Hospital, Beckett Street, Leeds LS9 7TF, United Kingdom.
Dr. Wass: Department of Endocrinology, The Radcliffe Infirmary, Woodstock Road, Oxford OX2 6HE, United Kingdom.
Author Contributions: Conception and design: P.J. Jenkins, R.R. Phillips, J.A.H. Wass, G.M. Besser, R.H. Rezneck.
Analysis and interpretation of the data: P.J. Jenkins, S.A. Sohaib, S. Akker, R.R. Phillips, K. Spillane, J.A.H. Wass, J.P. Monson, A.B. Grossman, G.M. Besser.
Drafting of the article: P.J. Jenkins, S.A. Sohaib, S. Akker, G.M. Besser.
Critical revision of the article for important intellectual content: P.J. Jenkins, S.A. Sohaib, S. Akker, R.R. Phillips, K. Spillane, J.A.H. Wass, J.P. Monson, A.B. Grossman, G.M. Besser, R.H. Rezneck.
Final approval of the article: P.J. Jenkins, S.A. Sohaib, S. Akker, R.R. Phillips, K. Spillane, J.A.H. Wass, J.P. Monson, A.B. Grossman, G.M. Besser, R.H. Rezneck.
Provision of study materials or patients: P.J. Jenkins, R.R. Phillips, J.A.H. Wass, J.P. Monson, A.B. Grossman, G.M. Besser, R.H. Rezneck.
Administrative, technical, or logistic support: S.A. Sohaib.
Collection and assembly of data: P.J. Jenkins, S.A. Sohaib, S. Akker, R.R. Phillips, K. Spillane.