1976 Volume 13 Issue 4 Pages 215-221
Achilles tendon xanthoma is an early clinical feature of hypercholesterolemia. To assess the diagnostic value of radiological examination of the Achilles tendon, its thickness was determined in 36 normal subjects having serum cholesterol level less than 250mg/dl and triglyceride less than 150mg/dl, 60 non-familial hyperlipidemic (23 combined hypercholesterol- and hypertriglyceridemic patients, 12 hypercholesterolemic and 11 hypertriglyceridemic patients), 13 secondary hypercholesterolemic (7 nephrotic syndrome, 6 hypothyroidism) and 20 familial hypercholesterolemic patients. The results were as follows:
1. The Achilles tendon was slightly thicker, although insignificant, in normal males (6.6±0.3mm) than in normal females (6.1±0.2mm).
2. The Achilles tendon thickness in non-familial hyperlipidemic patients was 6.1±0.2mm in combined hypercholesterol-and hypertriglyceridemic, 6.4±0.2 mm in hypercholesterolemic and 6.0±0.3mm in hypertriglyceridemic patients, and was not different from those in normal subjects.
3. The Achilles tendon thickness in secondary hypercholesterolemic patients (6.6±0.3mm in nephrotic syndrome, 6.8±0.5mm in hypothyroidism) was slightly thicker, although insignificant, than in normal subjects.
4. The Achilles tendon thickness in familial hypercholesterolemic patients was 13.2±0.9mm and significantly thicker than in normal, non-familial hyperlipidemic and secondary hypercholesterolemic subjects (p<0.01).
5. A significant positive correlation was found between the Achilles tendon thickness and the serum cholesterol level. There was no relationship between the Achilles tendon thickness and serum triglyceride level, body weight and age.
6. In familial hypercholesterolemia there was a significant positive correlation (r:0.475, p<0.05) between the Achilles tendon thickness and age.
7. Four patients with familial hypercholesterolemia had pain and tenderness in their Achilles tendons. The predominant lipids in the hypertrophied Achilles tendon were cholesterol ester, free cholesterol and phospholipids.
From these data it was concluded that the measurement of the Achilles tendon thickness seemed to be usefull in discriminating familial hypercholesterolemia from normal control, non-familial hyperlipidemia and secondary hypercholesterolemia.
