Is carpal tunnel syndrome a known side effect to growth hormone therapy?/nA 14-year-old girl with g

Fråga: Is carpal tunnel syndrome a known side effect to growth hormone therapy?

A 14-year-old girl with growth hormone deficiency developed pain and paresthesia in her hands 1-2 weeks after starting substitution therapy (0.1 IE/kg). Neurological examination has confirmed carpal tunnel syndrome.

Sammanfattning: Carpal tunnel syndrome has been described as a common side effect to growth hormone therapy in adults and as a rare side effect in children.

Svar: A literature search, including Medline and common pharmacological handbooks, has revealed one reference concerning growth hormone (GH) therapy and carpal tunnel syndrome. To monitor the safety of recombinant human GH, data has been collected from over 19000 treated children in Canada and the USA since 1985. Data on adverse events is collected at each follow-up visit as well as from spontaneous reporting. The main side effects reported in this study were idiopathic intracranial hypertension (20 cases), edema or lymphedema (26 cases), diabetes mellitus (21 cases) and slipped capital femoral epiphysis (28 cases). Carpal tunnel syndrome was reported in five children, aged 9-19 years, two of which had symptoms of fascial compartment syndromes before GH treatment. The symptoms occurred from 3 months to 5.5 years after the start of treatment. According to the authors, carpal tunnel syndrome is much more common in GH treated adults, with an incidence of 3-12 per cent (1).

Among a total of 20 reports of GH side effects to the Swedish Adverse Drug Reactions Advisory Committee (SADRAC), there are no cases of carpal tunnel syndrome in either children or adults (2).

This case should be reported to SADRAC. 1 Blethen SL, Allen DB, Graves D, August G, Moshang T, Rosenfeld R: Extensive personal experience. Safety of recombinant deoxyribonucleic acid-derived growth hormone: the national cooperative growth study experience. J Clin Endocrinol Metab 1996; 81: 1704-1710 (enclosed) 2 The Swedish Adverse Drug Reactions Advisory Committee adverse reaction database