SEVERE PERIPHERAL NEUROPATHY AND ELEVATED PLANTAR PRESSURES CAUSING FOOT ULCERATION IN PITUITARY GIGANTISM

We report two patients with treated pituitary gigantism and peripheral neuropathy, one of whom has chronic foot ulceration. Detailed neuroph ysiological assessment was performed on both patients. The patient wit h foot ulceration had clinical and neurophysiological evidence of seve re neuropathy, whereas the patient without ulceration had only neuroph ysiological abnormalities. The sweating response to acetylcholine was markedly impaired in the feet of both patients, suggesting pedal auton omic denervation. Neither patient had evidence of diabetes mellitus an d detailed investigation failed to reveal an alternative cause of peri pheral neuropathy. Optical pedobarography revealed abnormally high pre ssure (> 10 kg/cm2) under the metatarsal heads of both patients, one s uch area coinciding with the area of ulceration. Thus in pituitary gig antism elevated plantar pressures may contribute to the development of foot ulceration when severe peripheral neuropathy is present. Further more, as in diabetes mellitus, impaired sweating may also increase the risk of ulceration as the resultant dry skin may develop fissures.