Cutaneous findings in patients with acromegaly and its relationship with concomitant endocrinopathies

Author:

An İsa1ORCID,Kahraman Filiz Cebeci2,Bilgiç Aslı3,Aktürk Aysun Şikar4,Albayrak Hülya5,Kartal Demet6,Çınar Salih Levent6,Solak Sezgi Sarıkaya7,Uslu Meltem8,Şanlı Hatice Erdi9,Yıldızhan İncilay Kalay9,Şahin Mustafa Turhan10,Zindanci İlkin11,Savaş Sevil12,Ayhan Erhan13,Cinel Murat14,Ataş Elif Nazlı Serin15,Aydemir Mustafa15,Selek Alev16,Elbüken Gülşah17,Zuhur Sayid Shafi17,Karaca Züleyha18ORCID,Bülbül Buket Yılmaz19,Ünübol Mustafa20,Demir Özgür21,Hekimsoy Zeliha22,Tuna Mazhar23,Asilsoy Miray24,Çetin Sedat25

Affiliation:

1. Department of Dermatology Şanlıurfa Training and Research Hospital Sanlıurfa Turkey

2. Department of Dermatology Göztepe Prof. Dr. Süleyman Yalçın City Hospital İstanbul Turkey

3. Department of Dermatology Akdeniz University Medical Faculty Antalya Turkey

4. Department of Dermatology Kocaeli University Medical Faculty Kocaeli Turkey

5. Department of Dermatology Namık Kemal University Medical Faculty Turkey

6. Department of Dermatology Erciyes University Medical Faculty Kayseri Turkey

7. Department of Dermatology Trakya University Medical Faculty Edirne Turkey

8. Department of Dermatology Adnan Menderes University Medical Faculty Turkey

9. Department of Dermatology Ankara University Medical Faculty Ankara Turkey

10. Department of Dermatology Celal Bayar University Medical Faculty Manisa Turkey

11. Department of Dermatology Umraniye Training and Research Hospital İstanbul Turkey

12. Department of Dermatology İstanbul Training and Research Hospital İstanbul Turkey

13. Department of Dermatology Gazi Yaşargil Training and Research Hospital Diyarbakır Turkey

14. Department of Endocrinology and Metabolism Mehmet Akif Inan Education and Research Hospital Şanlıurfa Turkey

15. Department of Endocrinology and Metabolism Akdeniz University Medical Faculty Antalya Turkey

16. Department of Endocrinology and Metabolism Kocaeli University Medical Faculty Kocaeli Turkey

17. Department of Endocrinology and Metabolism Namık Kemal University Medical Faculty Turkey

18. Department of Endocrinology and Metabolism Erciyes University Medical Faculty Kayseri Turkey

19. Department of Endocrinology and Metabolism Trakya University Medical Faculty Edirne Turkey

20. Department of Endocrinology and Metabolism Adnan Menderes University Medical Faculty Turkey

21. Department of Endocrinology and Metabolism Ankara University Medical Faculty Ankara Turkey

22. Department of Endocrinology and Metabolism Celal Bayar University Medical Faculty Manisa Turkey

23. Department of Endocrinology and Metabolism Umraniye Training and Research Hospital İstanbul Turkey

24. Department of Endocrinology and Metabolism Sultan 2. Abdulhamid Han Training and Research Hospital İstanbul Turkey

25. Department of Endocrinology and Metabolism Gazi Yaşargil Training and Research Hospital Diyarbakır Turkey

Abstract

AbstractObjectivesSkin 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.Design, Patients, and MeasurementsIn 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.ResultsThe 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).ConclusionsCutaneous 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.

Publisher

Wiley

Reference26 articles.

1. Clinical Manifestations of Acromegaly

2. Cutaneous findings in patients with acromegaly;Akoglu G;Acta Dermatovenerol Croat,2013

3. Cutaneous manifestations of acromegaly;Dahbar M;Dermatol Argent,2009

4. Insulin Resistance in Patients With Acromegaly

5. Cutaneous signs of acromegaly

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