July - September 2024, Volume 20, Issue 3

Kurtulmus N, Kayikci K, Yarman S

Clinically Silent Somatotroph Adenoma Presenting with Acute Carpal Tunnel Syndrome: A Case with 14-Year Follow-Up and Review of the Literature

Acta Endo (Buc) 2024, 20 (3): 403-407
doi: 10.4183/aeb.2024.403

Objective. Carpal tunnel syndrome(CTS) is a neuropathy of the upper limb that is quite common in patients with active acromegaly, but the diagnosis of acromegaly is often made years after the diagnosis of CTS. But in the absence of the typical acral phenotype it is difficult to know when CTS will appear as the first symptom. Method. Here, we present a 27-year-old female patient with a history of numbness that first appeared in her right hand and 2 weeks later in her left hand. While the etiology of acute CTS was being investigated on cervical MRI, the hormonal evaluation of the incidentally detected mass in the sella turcica revealed that it was a clinically silent somatotroph adenoma. Results. Considering the patient's age, desire to have children, lack of typical acral features, the fact that these adenomas may cause phenotypic changes over time, their aggressive course and more recurrences, the decision for transsphenoidal surgery was made. The patient, who has been followed for 14 years, has two healthy children and does not have any complaints, acral phenotype or GH hormone excess. Conclusion. Awareness that acute unilateral/ bilateral CTS without any risk factors may be the first sign of clinically silent somatotrophinoma may improve the prognosis of acromegaly by preventing diagnostic delay.

Keywords: Carpal tunnel syndrome, clinical silent somatotroph adenoma, pregnancy, AIP gene, prognosis.

Correspondence: Neslihan Kurtulmus, Maslak Hospital of Acibadem Medical Faculty, Endocrinology Clinic, Acibadem University, Buyukdere Cad. No:40, Sariyer-Istanbul-Türkiye, E-mail: neslihandr@hotmail.com