Endocrine Abstracts

Background: Carpal tunnel syndrome (CTS) is common in patients with acromegaly, with a reported prevalence of 19–64%. We have studied CTS in a large national cohort of patients with acromegaly, and the temporal relationship between the diagnosis of the two diseases.

Methods: Retrospective nationwide cohort study including patients diagnosed with acromegaly in Sweden between 2005 and 2017. Patients with acromegaly were identified in the Swedish National Patient Registry. Diagnosis of CTS and its potential risk factors, such as diabetes mellitus and acromegaly treatments were collected from the Swedish National Health Registries from 8.5 years before the diagnosis of acromegaly until death or end of the study. Standardized incidence ratio (SIRs) with 95% confidence intervals (CIs) were calculated with the Swedish population as reference. Cox regression models were used to identify potential risk factors for CTS in patients with acromegaly.

Results: The analysis included 556 patients with acromegaly (278 women, 50%), diagnosed at a mean age of 50 ± 15 years. CTS was diagnosed in 48 (8.6%) patients, and 41 (7.4%) had been operated for CTS during the study period. SIR (95% CI) for CTS was 3.8 (2.8 – 5.0). The risk for CTS was similar for acromegaly patients with and without diabetes mellitus (SIR 3.5, 95% CI 1.6 – 6.7 vs SIR 3.9, 95% CI 2.7 – 5.3). Women with acromegaly had a higher risk (HR 2.5, 95% CI 1.3 – 4.7, P = 0.0038) for CTS than men. CTS was diagnosed prior to acromegaly diagnosis in 42 out of 48 (88%) of the patients (median 3.1 years earlier, range 0.3 – 8.5 years). Thirty-five of 41 (85%) patients operated for CTS had undergone surgery before the diagnosis of acromegaly (median time 2.2 years, range 0.3 – 8.5 years).

Conclusion: Patients with acromegaly have a four times higher incidence of CTS compared to the general population. The vast majority of patients are diagnosed with CTS prior to acromegaly. The increased risk of CTS and the temporal relationship indicate a potential time-window for shortening the diagnostic delay in acromegaly by increasing the awareness of acromegaly in patients with CTS.