Tagliafico Alberto, Resmini Eugenia, Nizzo Raffaella, Bianchi Federico, Minuto Francesco, Ferone Diego, Martinoli Carlo
Department of Radiology, University of Genova, viale Benedetto XV, 6, 16132 Genova, Italy.
J Clin Endocrinol Metab. 2008 Mar;93(3):905-9. doi: 10.1210/jc.2007-1719. Epub 2007 Dec 11.
Acromegalic patients may complain of sensory disturbances in their hands.
Our objective was to examine median (MN) and ulnar nerves (UN) of acromegalic patients with ultrasound (US) and to determine whether nerve abnormalities correlate with clinical parameters and nerve conduction studies (NCS).
We prospectively examined the MN and UN in 34 nondiabetic, acromegalic patients (18 females and 16 males; age range 18-79 yr) and 34 sex-, age-, and body mass index-matched controls with 17-5 MHz US.
The MN was examined at the carpal tunnel (MN-Ct) and at mid-forearm (MN-f) levels; the UN at the mid-forearm (UN-f) and distal arm (UN-a). A total of 272 nerve cross-sectional areas (CSA) were recorded from both patients and controls. In addition, 22 patients underwent NCS.
Nerves of acromegalic patients (MN-Ct=16.5+/-4.4 mm2; MN-f=10.5+/-2.4 mm2; UN-f=9.5+/-3.0 mm2; UN-a=13.1+/-3.7 mm2) had significantly (P<0.0001) greater CSA compared with controls (MN-Ct=7.4+/-1.7 mm2; MN-f=5.5+/-1.4 mm2; UN-f=5.3+/-1.4 mm2; UN-a=6.6+/-1.7 mm2). NCS displayed at least one abnormality in 59% of patients. Acromegalic patients, grouped according to disease activity (14 controlled, 8 partially controlled, 12 uncontrolled), had significantly (P<0.0001) greater CSA compared with controls. Nerve CSA were significantly greater in uncontrolled patients compared to controlled, both at MN-Ct and at UN-f levels (P<0.01). Abnormal NCS were observed in five of seven uncontrolled patients and four of nine controlled patients. IGF-I levels, but not GH levels, were correlated with CSA (r=0.34), whereas disease duration correlated with both nerve CSA and NCS (r=0.33 and r=0.31).
US identified a significantly increased volume of MN and UN in acromegalic patients. Peripheral nerve enlargement in acromegaly seems to be an intrinsic feature of the disease related to clinical control, disease duration, and IGF-I levels.
肢端肥大症患者可能会抱怨手部感觉障碍。
我们的目的是用超声（US）检查肢端肥大症患者的正中神经（MN）和尺神经（UN），并确定神经异常是否与临床参数和神经传导研究（NCS）相关。
我们前瞻性地用17-5MHz超声检查了34例非糖尿病肢端肥大症患者（18例女性和16例男性；年龄范围18-79岁）以及34例性别、年龄和体重指数匹配的对照者的MN和UN。
在腕管（MN-Ct）和前臂中部（MN-f）水平检查MN；在前臂中部（UN-f）和上臂远端（UN-a）检查UN。共记录了患者和对照者的272个神经横截面积（CSA）。此外，22例患者接受了NCS。
肢端肥大症患者的神经（MN-Ct=16.5±4.4mm²；MN-f=10.5±2.4mm²；UN-f=9.5±3.0mm²；UN-a=13.1±3.7mm²）与对照者相比，CSA显著更大（P<0.0001）（对照者：MN-Ct=7.4±1.7mm²；MN-f=5.5±1.4mm²；UN-f=5.3±1.4mm²；UN-a=6.6±1.7mm²）。NCS显示59%的患者至少有一项异常。根据疾病活动度分组的肢端肥大症患者（14例病情得到控制，8例部分得到控制，12例未得到控制）与对照者相比，CSA显著更大（P<0.0001）。在MN-Ct和UN-f水平，未得到控制的患者的神经CSA显著大于病情得到控制的患者（P<0.01）。在7例未得到控制的患者中有5例观察到NCS异常，在9例病情得到控制的患者中有4例观察到NCS异常。胰岛素样生长因子-I（IGF-I）水平而非生长激素（GH）水平与CSA相关（r=0.34），而病程与神经CSA和NCS均相关（r=0.33和r=0.31）。
超声显示肢端肥大症患者的MN和UN体积显著增加。肢端肥大症中的周围神经增粗似乎是该疾病的一个内在特征，与临床控制、病程和IGF-I水平有关。
