Carpal tunnel syndrome, surgery common before acromegaly diagnosis
Adults with acromegaly have a sixfold higher incidence rate of carpal tunnel syndrome compared with the general population, with most diagnosed and undergoing surgery before the acromegaly diagnosis, according to a retrospective study.
“Our colleagues in endocrinology should consider the presence or history of carpal tunnel syndrome when assessing a patient with suspected or confirmed acromegaly, especially female patients,” Konstantina Vouzouneraki, MD, a doctoral student in the department of public health and clinical medicine at Umeå University, Sweden, told Healio. “Furthermore, the considerably higher incidence of carpal tunnel syndrome prior to acromegaly may be a factor that could contribute to reducing the extensive diagnostic delay in acromegaly. This remains to be seen, and we are looking forward to seeing more studies investigating this matter.”
In a retrospective study, Vouzouneraki and colleagues analyzed data from 556 patients diagnosed with acromegaly in Sweden from 2005 to 2017, identified in the Swedish Healthcare Quality Registries (50% women; mean age at diagnosis, 50 years).
Diagnosis and surgery for carpal tunnel syndrome was analyzed from 8.5 years before the diagnosis of acromegaly until death or end of the study. Researchers calculated standardized incidence ratios (SIRs) for carpal tunnel syndrome, with the Swedish population as reference. The findings were published in the European Journal of Endocrinology.
During the study period, 48 patients were diagnosed with carpal tunnel syndrome and 41 patients underwent at least one surgery for carpal tunnel syndrome. Among those who underwent surgery, 35 patients, or 85%, had surgery a mean 2.2 years before the acromegaly diagnosis.
The SIR for having carpal tunnel syndrome surgery before diagnosis of acromegaly was 6.6 (95% CI, 4.8-8.9). Women with acromegaly had a higher risk for carpal tunnel syndrome than men, with an HR of 2.5 (95% CI, 1.3-4.7).
“As a clinical endocrinologist, I believe that achieving a reduction of the long diagnostic delay in acromegaly, often longer than 6 years, would considerably improve the health and quality of life for these patients,” Vouzouneraki said. “Awareness of comorbidities in these patients among endocrinologists may be a good start to reduce this delay and is pointed out in recent clinical guidelines. The next step would be to increase the awareness of acromegaly in the broader medical community, especially within specialties attending for acromegaly-related comorbidities. However, since acromegaly is a rare disease, we would benefit from a more targeted approach in the group of patients with higher risk for acromegaly and we need more data on how much each comorbidity or combinations of other diagnosis increases the risk of having an undiagnosed acromegaly.”
For more information:
Konstantina Vouzouneraki, MD, can be reached at firstname.lastname@example.org.