Sasagawa Yasuo, Tachibana Osamu, Doai Mariko, Tonami Hisao, Iizuka Hideaki
Department of Neurosurgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, 920-0293, Ishikawa, Japan,
Pituitary. 2015 Oct;18(5):695-700. doi: 10.1007/s11102-015-0642-9.
Carpal tunnel syndrome (CTS) often occurs with acromegaly; however, the pathophysiology of CTS in acromegalic patients remains unclear. This study evaluated the median nerve in acromegalic patients with and without CTS.
We examined the median nerves of 21 acromegalic patients (eight patients with CTS and 13 patients without CTS) using electrophysiological nerve conduction studies and wrist magnetic resonance images. They underwent transsphenoidal surgery to resect their growth hormone-secreting pituitary adenomas. The median nerves of the patients with CTS were reassessed by the same studies.
The sensory conduction velocity was significantly later in the median nerves of patients with CTS than in patients without CTS (34.9 vs. 45.8 m/s, respectively; P = 0.006). In the wrist magnetic resonance images, the cross-sectional area of the median nerve in CTS patients and non-CTS patients was 18.7 and 10.5 mm(2), respectively. The median nerve was significantly larger in patients with CTS than in patients without CTS (P < 0.003). The flattering ratio of the median nerve and palmar deviation of the flexor retinaculum were not significantly different between the two patient groups. After tumor resection, the nerve conduction velocities improved in patients with CTS, but the nerve remained enlarged. The CTS symptoms disappeared in all patients, except one.
The median nerves of acromegalic patients with CTS were enlarged and had impaired nerve conduction. This finding represents a predominant intrinsic feature in the pathophysiology of the disease rather than an extrinsic feature such as a thickened transverse carpal ligament.
腕管综合征（CTS）常与肢端肥大症同时出现；然而，肢端肥大症患者发生CTS的病理生理学机制仍不清楚。本研究评估了患有和未患有CTS的肢端肥大症患者的正中神经。
我们使用电生理神经传导研究和腕部磁共振成像检查了21例肢端肥大症患者（8例患有CTS，13例未患有CTS）的正中神经。他们接受了经蝶窦手术以切除分泌生长激素的垂体腺瘤。对患有CTS的患者的正中神经进行了相同研究的重新评估。
CTS患者正中神经的感觉传导速度明显慢于未患CTS的患者（分别为34.9与45.8 m/s；P = 0.006）。在腕部磁共振图像中，CTS患者和非CTS患者正中神经的横截面积分别为18.7和10.5 mm²。CTS患者的正中神经明显大于未患CTS的患者（P < 0.003）。两组患者正中神经的扁平率和屈肌支持带的掌侧偏斜无显著差异。肿瘤切除后，CTS患者的神经传导速度有所改善，但神经仍肿大。除1例患者外，所有患者的CTS症状均消失。
患有CTS的肢端肥大症患者的正中神经肿大且神经传导受损。这一发现代表了该疾病病理生理学中的一个主要内在特征，而非外在特征，如腕横韧带增厚。
