目的:肢端肥大症的皮肤改变通常是该病的首发症状。这项研究的目的是描述肢端肥大症患者的皮肤发现。此外,次要目的是研究这些发现与缓解状态和伴随的内分泌疾病之间的可能关联.
■在这项前瞻性多中心研究中,包括278名年龄超过18岁的肢端肥大症患者,他们在14个不同的三级医疗机构进行了随访。这些病人,他们被内分泌科跟进,然后转交给皮肤科医生进行皮肤科检查。通过详细的皮肤病学检查调查皮肤病变的频率。皮肤病学诊断是通过临床,皮肤病学和/或皮肤镜检查,在可疑病例中很少进行皮肤穿刺活检。评估了缓解和未缓解患者之间的皮肤发现以及伴随的内分泌疾病之间的可能关联。
结果:在我们的研究中,肢端肥大症患者最常见的皮肤表现是皮肤标记(52.5%),樱桃血管瘤(47.4%),脂溢(37%),静脉曲张(33%),痤疮样病变(28.8%),多汗症(26.9%)和多毛症(18.3%)。多毛症在未缓解的患者中明显更普遍(p:.001),而皮肤干燥在缓解患者中明显更普遍(p:.001)。静脉曲张和脂溢性角化病患者的糖尿病和甲状腺功能减退的频率明显高于无静脉曲张和脂溢性角化病患者。此外,甲状腺功能减退的共存,樱桃血管瘤患者的甲状腺功能亢进和溢乳明显高于无樱桃血管瘤患者(p值分别为.024,.034和.027).皮肤干燥患者的性腺功能减退频率显着高于无皮肤干燥患者(p:.035)。
结论:皮肤雄激素化发现,如皮肤标签,脂溢,痤疮和黑棘皮病在肢端肥大症患者中很常见。临床医生应该意识到,这些患者可能会出现与胰岛素抵抗相关的皮肤发现。可以说,肢端肥大症的缓解状态对皮肤表现没有疗效。只有缓解期的患者不太可能患有多毛症。这可能允许对表现为多毛症的肢端肥大症患者的随访和治疗进行更早的审查。此外,可以说,患有诸如樱桃血管瘤之类的皮肤发现的患者可能易患第二内分泌病,尤其是甲状腺功能减退.在肢端肥大症患者管理的多学科角度中包括皮肤科将有利于更早地检测皮肤发现。
OBJECTIVE: Skin changes in acromegaly are often the first sign of the disease. The aim of this study was to describe the cutaneous findings in patients with acromegaly. In addition, a secondary aim was to investigate the possible association of these findings with remission status and concomitant endocrinopathies.
UNASSIGNED: In this prospective multicenter study, 278 patients over the age of 18 years with acromegaly who were followed up in 14 different tertiary healthcare institutions were included. These patients, who were followed up by the Endocrinology Department, were then referred to a dermatologist for dermatological examination. The frequency of skin lesions was investigated by detailed dermatologic examination. Dermatological diagnosis is reached by clinical, dermatological and/or dermoscopic examination, and rarely skin punch biopsy examinations in suspicious cases. The possible association of the skin findings between remitted and nonremitted patients and with concomitant endocrinopathies were evaluated.
RESULTS: The most common skin findings in patients with acromegaly in our study were skin tags (52.5%), cherry angiomas (47.4%), seborrhoea (37%), varicose veins (33%), acneiform lesions (28.8%), hyperhidrosis (26.9%) and hypertrichosis (18.3%). Hypertrichosis was significantly more prevalent in patients nonremitted (p: .001), while xerosis cutis was significantly more prevalent in patients remitted (p: .001). The frequency of diabetes mellitus and hypothyroidism was significantly higher in patients with varicose veins and seborrhoeic keratosis than those without. Additionally, the coexistence of hypothyroidism, hyperthyroidism and galactorrhea was significantly higher in patients with Cherry angioma than in those without Cherry angioma (p-values: .024, .034 and .027, respectively). The frequency of hypogonadism in those with xerosis cutis was significantly higher than in those without (p: .035).
CONCLUSIONS: Cutaneous androgenization findings such as skin tag, seborrhoea, acne and acanthosis nigricans are common in patients with acromegaly. Clinicians should be aware that skin findings associated with insulin resistance may develop in these patients. It can be said that the remission state in acromegaly has no curative effect on cutaneous findings. Only patients in remission were less likely to have hypertrichosis. This may allow earlier review of the follow-up and treatment of acromegaly patients presenting with complaints of hypertrichosis. Additionally, it can be said that patients with skin findings such as cherry angioma may be predisposed to a second
endocrinopathy, especially hypothyroidism. Including dermatology in a multidisciplinary perspective in acromegaly patient management would be beneficial to detect cutaneous findings earlier.