Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
Images in Dermatology
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
Images in Dermatology
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology

Translate this page into:

ORIGINAL CONTRIBUTIONS
1997:63:3;178-180
PMID: 20944316

Skin manifestations of acromegaly - a study of 34 cases

Kavita R Arya, K Krishna, M Chadda
 Department of Medicine and Endocrinology, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai - 400 012, India

Correspondence Address:
Kavita R Arya
23, Sopan Baug Co-operative Housing Society, Pune - 411 001
India
How to cite this article:
Arya KR, Krishna K, Chadda M. Skin manifestations of acromegaly - a study of 34 cases. Indian J Dermatol Venereol Leprol 1997;63:178-180
Copyright: (C)1997 Indian Journal of Dermatology, Venereology, and Leprology

Abstract

The common dermatological manifestations seen in 34 cases of acromegaly were changes in facial appearance, enlargement of hands and feet, intolerance to heat and sweating, carpal tunnel syndrome, hirsutism, acrochordons and acanthosis nigricans. The mean estimated age of onset was 32.8 years in males and 31.7 years in females, while the mean age at the time of diagnosis was 38.6 years and 36.1 years for males and females respectively, with a slight male preponderance noted.
Keywords: Acromegaly, Acanthosis nigricans, Growth hormone

The term "acromegaly" was coined by Pierre Marie in 1886,[1] though he was not the first person to describe this clinical entity and in fact he had refuted the idea of pituitary hyperfunction. Minkowaski in 1887, when describing a patient with headache and hemianopia, was the first to suggest that pituitary dysfunction caused acromegaly.[1]

Excessive secretion of growth hormone starting after or around the time of closure of epiphyses of the long bones results in acromegaly. Gigantism results when the excessive secretion of growth hormone begins before the epiphyses close. However, patients with gigantism almost always develop the clinical features of acromegaly because over-production of growth hormone continues long after closure of the epiphyses of the long bones. The lesions responsible for the excessive production may be hypothalamic, hypophyseal or ectopic in origin producing growth hormone or growth hormone releasing factor.[1]

Subjects and Methods

The study was conducted at the Department of Medicine and Endocrinology, KEM hospital, Mumbai during a period of five years. Acromegaly was diagnosed on the basis of basal and post glucose growth hormone levels measured by radioimmunoassay. The upper limit of growth hormone levels is 5 ng/ml which should suppress below 1ng/ml after a glucose load.

Results

The mean estimated age of onset (calculated by age at presentation in years - duration of symptoms in years) was 32.8 years (range 17-58 years) in males and 31.7 years (range 6-57 years) in females. The mean age at the time of diagnosis for males was 38.6 years (range 22-65 years) and for females was 36.1 years (range 12-57 years). The incidence in males was slightly higher, 19 men (55.8%) and 15 women (44.2%).

The skin manifestations including the presenting symptoms and those detected at the time of diagnosis are listed in [Table - 1]

Discussion

Acromegaly is not a common disease. Alexander et al from a study in the north of England suggested a prevalence of diagnosed cases of 40 per million of population.[2] The sex distribution of our cases showed slight male predominance (19 men, 15 women) comparable with Nabarro′s series (133 males, 123 females).[3] Two of our patients, both females, presented to us during adolescence, with rapid increase in height. After the epiphyses have fused, early clinical changes are enlargement of fingers - need to have rings enlarged and changes in shoe size. The estimated age of onset in this series varied from 6 to 57 years in females (mean 31.7 years) and 17 to 58 years in males (mean 32.8 years), comparable with Nabarro′s series of 256 patients.[3]

Acromegaly causes changes in the skin, cardiovascular, respiratory, central nervous, musculoskeletal and endocrine systems. In the skin, changes are most pronounced in the connective tissue of the dermis, with an increase in the content of glycosaminoglycans with proportional increases in chondroitin and dermatan sulphate, and the attendant retention of water. Also, there is hyperplasia of the epidermis and dermal appendages, along with effects on the pilosebaceous structures by potentiating the effectiveness of the available androgen.[4]

Thickening of the subcutaneous tissues affecting particularly the face, the fingers and the heel pads was present in all patients. Hyperhidrosis was noted in 32.3% of the patients. The prevalance of increased sweating reported in previous series has varied from 65%,[5] to 88%.[6] Three young women (8.8%) with severe acromegaly and very high growth hormone levels, had typical acanthosis nigricans, most obvious in the axillae and nape of the neck. This is well recongnised in young acromegalics both male and female,[7] and has a reported incidence of 29%.[6] Four of our female patients (26.6%) had hirsutism mainly involving chest, sacral area and extremities with relative sparing of the face comparable with 24% incidence in Nabarro′s series.[3] Skin tags, especially over the trunk were reported in 27%,[8] to 45%.[6] Two of our patients (5.9%) had acrochordons over the neek, axillae and trunk. However, Nabarro reported cutis vertices gyrata due to soft tissue thickening of the scalp in 4 patients,[3] which was not seen in any of our cases.

The features of skeletal overgrowth were seen in all patients - protrusion of lower jaw with malocclusion of teeth, wide spacing of teeth, and enlargement of hands and feet. Carpal tunnel syndrome, with tingling and parasthesiae in the hands, more at night was seen in seven of our patients (20.6%), 4 men (21%) and 3 women (20%) respectively. The incidence reported in other series has been 25%.[3]

Acknowledgements

We thank Dr. P.S. Menon, Professor and Head, Department of Endocrinology, K.E.M. Hospital for her suggestions and guidance. We also thank the Dean, Seth G.S. Medical college and K.E.M. Hospital for permitting us to publish hospital data.

References
1.
Randall RV. Acromegaly and gigantism. In: Endocrinology, second edition, editors, De Groot LJ, Besser GM, Cahill GF Jr et al. WB Saunders, Philadelphia, 1989;330-350.
[Google Scholar]
2.
Alexander L, Appelton D, Hall R et al. Epidemiology of acromegaly in the New Castle region Clin Endocrinol 1980;12:71-79.
[Google Scholar]
3.
Nabarro JDN. Review - acromegaly. Clin Endocrinol 1987;26:481-512.
[Google Scholar]
4.
Freinkel RK, Freinkel N. Cutaneous manifestations of endocrine disorders, In: Dermatology in General Medicine, Third ed, volume 2, Editors, Fitzpatrick TB, Eizen AZ, Wolff K et al, Mc Graw Hill Information Services Company, New York, 1987;2063-2081.
[Google Scholar]
5.
Jadresic P. The acromegaly syndrome: relation between clinical features, growth hormone values and radiological characteristics of pituitary tumours. Quart J Med 1982;51:189-204.
[Google Scholar]
6.
Tyrrell JB, Wilson CB. Pituitary syndromes. In: Surgical Endocrinology Clinical Syndromes, Editor, Freisen SR, JB Lippincott, Philadelphia, 1978;304-324.
[Google Scholar]
7.
Brown J, Winkelmann RK, Randall RV. Acanthosis and pituitary tumors: Report of eight cases, JAMA 1966;198:619-623.
[Google Scholar]
8.
Davidoff LM. Studies in acromegaly III. The anamnesis and symptomatology in one hundred cases, Endocrinology 1926;10:461-483.
[Google Scholar]
Show Sections