In box 2 of their article, the authors list among the rare differential diagnoses non-neurogenic or other disorders.
What is missing is any mention of a rare disease, such as acromegaly, which affects patients’ lives on the long term and is often diagnosed only years later (10–15 years as a rule). In most cases it falls to general practitioners to detect acromegaly (1). In up to 64% of patients with acromegaly, bilateral carpal tunnel syndrome is found at the initial presentation (2). We know from MRI studies that the median nerve is swollen in such patients because of the excess growth hormone (3). Carpal tunnel syndrome usually disappears after the acromegaly has been treated successfully. It is regrettable that nothing has changed and acromegaly is still diagnosed only after the carpal tunnel syndrome has been treated. In patients with acromegaly, carpal tunnel syndrome is an important indication for early detection—not only after surgery or recognition as an occupational disease.
References
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