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The pathology of ulnar nerve in acromegaly

A Tagliafico, Department of Radiology R, DICMI, University of Genova, Genova, Italy
E Resmini, Department of Endocrine & Medical Sciences, University of Genova, Genova, Italy
R Nizzo, Department of Neurophysiology, University of Genova, Genova, Italy
L Derchi, Department of Radiology R, DICMI, University of Genova, Genova, Italy
F Minuto, Department of Endocrine & Medical Sciences, University of Genova, Genova, Italy
M Giusti, Department of Endocrine & Medical Sciences, University of Genova, Genova, Italy
C Martinoli, Department of Radiology R, DICMI, University of Genova, Genova, Italy
D Ferone, Department of Endocrine & Medical Sciences, University of Genova, Genova, Italy

Correspondence: Diego Ferone, Email: ferone{at}unige.it

Abstract

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 asses the prevalence of UCT in acromegalic patients and the effects of one 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 hypotiroidism with clinical examination, nerve conduction studies (NCS) and high-resolution ultrasound (US). A control group was made by 50 volunteers. Local ethic 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 one year.

Results: In 8/37 patients a diagnosis of UCT was made at the beginning of the study reflecting a prevalence of 21%. After one year 5/8 (62.5%) patients reported clinical and NCS improvements and evident US reduction of nerve CSA (16.7+/-2.9 mm2 vs 12.2+/-3.1 mm2; p<0.001). In 3/8 (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 tunnel syndrome and carpal tunnel syndrome in acromegaly.