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The pathology of the ulnar nerve in acromegaly

Departments of¹ Radiology ‘R’, DICMI² , Endocrinological and Medical Sciences (DiSEM) and Center of Excellence for Biomedical Research³ Neurophysiology, University of Genova, Viale Benedetto XV, 6, I-16132 Genova, Italy

(Correspondence should be addressed to D Ferone; Email: ferone{at}unige.it)

Context: Acromegalic patients may complain of sensory disturbances in their hands. Cubital tunnel syndrome, the ulnar nerve neuropathy at the cubital tunnel (UCT), in acromegalic patients has never been reported.

Objective: To describe and assess the prevalence of UCT in acromegalic patients and the effects of 1 year of therapy on UCT.

Patients: We examined prospectively 37 acromegalic patients with no history of polyneuropathy, acute trauma at the elbow, no diabetes or hypothyroidism with clinical examination, nerve conduction studies (NCS), and high-resolution ultrasound (US). A control group was made by 50 volunteers. The local ethics committee approved the study and written informed consent was obtained from all subjects involved in the study.

Intervention: Clinical history, physical examination, NCS, and US were used to diagnose UCT at the beginning of the study and after 1 year.

Results: In 8 of 37 patients, a diagnosis of UCT was made at the beginning of the study reflecting a prevalence of 21%. After 1 year, 5 of 8 (62.5%) patients reported clinical and NCS improvements and evident US reduction of nerve cross-sectional area (CSA; 16.7±2.9 mm² vs 12.2±3.1 mm²; P<0.001). In 3 of 8 (37.5%) patients, the UCT was unchanged. Ulnar nerve CSA was significantly increased in acromegalic patients with UCT (16.7±2.9 mm² vs 11.1±2.3 mm²; P<0.047).

Conclusion: Ulnar neuropathy could occur in acromegalic patients and can improve in 62% of cases with disease control. Due to the different management and therapeutic approach, it would be important to make differential diagnosis between cubital and carpal tunnel syndrome in acromegaly.