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Abstract
Acanthosis nigricans (AN) occurs most commonly in association with hyperinsulinaemia and more rarely as a paraneoplastic syndrome. It is also a feature of several genetic disorders. Indirect evidence suggests a role for tyrosine kinase growth factor receptor signalling in the pathogenesis of AN. Defects in the insulin receptor gene causing insulin resistance and AN are well recognized, but recent data in several other syndromes of this association, including lipodystrophic disorders, have identified causative defects in other pathways. The mechanism of AN due to insulin resistance is most probably direct or indirect activation of the insulin-like growth factor 1 receptor by high levels of circulating insulin. However, more direct evidence for abnormal tyrosine kinase receptor signalling in AN has been provided by studies of craniosynostosis and skeletal dysplasia syndromes with AN, which have identified activating mutations in fibroblast growth factor receptors.
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Affiliation(s)
- D Torley
- Department of Dermatology, South Glasgow University Hospitals NHS Trust, Glasgow G51 4TF, Scotland, U.K
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152
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Araújo LMB, Viveiros AMCD, Lopes RC, Viana ADC, Fukui RT, Ursich MJM. Acanthosis nigricans em mulheres obesas de uma população miscigenada: um marcador de distúrbios metabólicos. An Bras Dermatol 2002. [DOI: 10.1590/s0365-05962002000500003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
FUNDAMENTOS:Acanthosis nigricans (AN) tem sido associada a diversos distúrbios metabólicos e endócrinos. OBJETIVOS: O objetivo deste estudo é avaliar a freqüência das co-morbidades da síndrome metabólica em mulheres obesas de uma população miscigenada com AN, comparada a um grupo sem AN. CASUÍSTICA E MÉTODOS: Foram estudadas 481 mulheres, consecutivamente admitidas em um ambulatório de obesidade (388 com AN e 93 sem AN) e submetidas ao teste de tolerância à glicose oral, excetuando-se 20, que já se sabiam diabéticas. RESULTADOS: A distribuição segundo a raça indicou 34,5% de brancas, 38,9% de pardas e 26,6% de negras. A freqüência global de AN foi de 80,7%, sendo fortemente maior nas negras versus brancas (90,6 % e 66,9%, p=0,000000) e negras versus pardas (86% e 90,6%, p= 0,000006). Foi também maior nas pardas versus brancas (86% e 66,9%, p<0,02). As pacientes com AN eram mais jovens (35 + 10 versus 38 + 10 anos, p < 0,01), mais obesas (41 + 6 versus 39 + 6 kg/m², p<0.01), tinham maior circunferência de cintura, maior freqüência de obesidade andróide, de diabetes tipo 2 (11,1% versus 4,3%, p=0,05), maiores níveis de insulina de jejum e de resistência insulina (Homa IR) do que aquelas sem AN. As freqüências de hipertensão diastólica e alterações do colesterol total e frações e de triglicérides entre os grupos foram similares. CONCLUSÃO: Em mulheres obesas de uma população miscigenada, AN foi mais freqüente nas de raça negra e parda e foi observada maior freqüência de co-morbidades da síndrome metabólica em comparação à população sem AN. As mulheres obesas com AN devem ser investigadas para distúrbios metabólicos, mesmo sendo jovens.
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153
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Abstract
Skin manifestations of systemic disease and malignancy are protean. The recognition of a potentially paraneoplastic dermatosis as such must prompt an investigation for occult malignancy. Lack of familiarity with cutaneous clues of internal malignancy may delay diagnosis and treatment of cancer. It is important to consider a paraneoplastic process in the differential diagnosis of a number of eruptive and treatment-resistant dermatoses. These dermatoses may be the first sign of an occult neoplasm. Their recognition may assist in cancer detection and the swift induction of appropriate therapy.
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Affiliation(s)
- Sarah Boyce
- Department of Dermatology, University of Alabama at Birmingham, EFH, Suite 414, Birmingham, AL 35294, USA
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154
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Cather JC, Menter MA. Leg Lesions and Velvety Hyperpigmentation on the Neck. Proc (Bayl Univ Med Cent) 2002; 15:327-8. [PMID: 16333458 PMCID: PMC1276631 DOI: 10.1080/08998280.2002.11927859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Jennifer Clay Cather
- Division of Dermatology, Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas, USA
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155
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Stoddart ML, Blevins KS, Lee ET, Wang W, Blackett PR. Association of acanthosis nigricans with hyperinsulinemia compared with other selected risk factors for type 2 diabetes in Cherokee Indians: the Cherokee Diabetes Study. Diabetes Care 2002; 25:1009-14. [PMID: 12032107 DOI: 10.2337/diacare.25.6.1009] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To report prevalence rates of acanthosis nigricans (AN) and hyperinsulinemia and the association of AN with hyperinsulinemia compared with other known or suspected risk factors for type 2 diabetes in young American Indians. RESEARCH DESIGN AND METHODS A random sample of Cherokee Nation members aged 5-40 years was invited to participate in the Cherokee Diabetes Study, a cross-sectional study of type 2 diabetes and its risk factors in a young American Indian population. Data were collected by personal interview, medical history, physical examination (including anthropometric and blood pressure measurements and examination of the neck for AN), and laboratory analyses of blood specimens. Levels of insulin, lipids, and glucose were measured on fasting blood specimens. Diabetes status was determined according to the American Diabetes Association criteria. RESULTS A total of 2,205 participants were examined. Overall prevalence rates for AN and hyperinsulinemia were 34.2 and 47.2%, respectively. In general, the rates for both increased with age and degree of Indian heritage and were higher in female subjects, overweight/obese individuals, those with type 2 diabetes, and those with a parental history of type 2 diabetes. In addition, both had significantly higher age- and sex-adjusted means for selected known or suspected risk factors for type 2 diabetes. AN remained significantly associated with hyperinsulinemia (P = 0.0001) in multivariate analysis. CONCLUSIONS AN is independently associated with hyperinsulinemia and therefore may be useful as an early indicator of high risk for diabetes.
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Affiliation(s)
- Martha L Stoddart
- Center for American Indian Health Research, University of Oklahoma Health Sciences Center, College of Public Health, Oklahoma City, Oklahoma 73190, USA.
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156
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157
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Abstract
Acanthosis nigricans in obese adolescents is frequently associated with hyperinsulinemia and insulin resistance. We report three cases of this condition. In the early stage the skin lesions appeared to be erythematous and pruritic, mimicking an inflammatory dermatitis. Dietary control and oral metformin hydrochloride markedly improved the lesions. Topical calcipotriol may also help to control the skin condition.
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Affiliation(s)
- Trinh Hermanns-Lê
- Department of Dermatopathology, University Medical Center of Liège, Liège, Belgium
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158
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Araújo LMB, Porto MV, Netto EM, Ursich MJ. Association of acanthosis nigricans with race and metabolic disturbances in obese women. Braz J Med Biol Res 2002; 35:59-64. [PMID: 11743615 DOI: 10.1590/s0100-879x2002000100008] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Acanthosis nigricans (AN) has been recognized as a marker of insulin resistance and diabetes mellitus. We have compared frequency of race and metabolic disturbances in obese women with several degrees of AN (AN group, N = 190) to a group without AN (non-AN group, N = 61) from a mixed racial population. The groups were similar regarding age and body mass index. All patients (except the diabetic patients) underwent an oral glucose tolerance test (75 g). The racial distribution of this population was 35.1% white, 37.8% mulatto and 27.1% black and the frequency of AN was 62.5, 82.1 and 83.8%, respectively, higher in black versus white (P = 0.003) and mulatto versus white (P = 0.002) women. The frequencies of diabetes mellitus and impaired glucose tolerance were 5.8 and 12.6% in the AN group and 1.6 and 8.2% in the non-AN group, respectively (P>0.05). Fasting glucose, beta cell function determined by the homeostasis model of assessment (HOMA), fasting insulin and insulin area under the curve were similar for the AN and non-AN groups. A higher HOMA insulin resistance was observed in the AN group compared to the non-AN group (P = 0.02) and in the subgroup of highest degree of AN compared to those with other degrees. The mean lipid levels and the frequency of dyslipidemia were similar for the two groups. AN was strongly associated with the black or mulatto rather than the white race, even after taking into account the effect of age, body mass index and HOMA insulin resistance.
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Affiliation(s)
- L M B Araújo
- Seção de Endocrinologia, Hospital Universitário Prof. Edgard Santos, Faculdade de Medicina, Universidade Federal da Bahia, Salvador, BA, Brasil.
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159
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Scully C, Barrett WA, Gilkes J, Rees M, Sarner M, Southcott RJ. Oral acanthosis nigricans, the sign of Leser-Trélat and cholangiocarcinoma. Br J Dermatol 2001; 145:506-7. [PMID: 11531848 DOI: 10.1046/j.1365-2133.2001.04393.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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160
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Cairo F, Rubino I, Rotundo R, Prato GP, Ficarra G. Oral Acanthosis nigricans as a marker of internal malignancy. A case report. J Periodontol 2001; 72:1271-5. [PMID: 11577962 DOI: 10.1902/jop.2000.72.9.1271] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Acanthosis nigricans (AN) is a rare mucocutaneous condition that can involve the oral tissues. There are 2 clinical forms of AN: benign and malignant. Benign AN is related to systemic diseases such as diabetes and obesity or can be induced by drugs such as systemic corticosteroids, nicotinic acid, estrogens, insulin, and fusidic acid. Malignant AN appears in association with tumors such as lung, ovarian, breast, and gastric carcinoma. METHODS A rare case of malignant AN that initially manifested in the oral cavity of a 73-year-old patient is reported. RESULTS A bladder and lung carcinoma were detected following the diagnosis of AN. CONCLUSIONS The diagnostic importance of oral AN is emphasized because, in our patient, its recognition led to the detection of 2 occult malignant tumors.
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Affiliation(s)
- F Cairo
- School of Dental Medicine, University of Florence, Italy
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161
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Munoz-Perez MA, Camacho F. Acanthosis nigricans: A new cutaneous sign in severe atopic dermatitis and Down syndrome. J Eur Acad Dermatol Venereol 2001. [DOI: 10.1046/j.1468-3083.2001.00239.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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162
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Muñoz-Pérez MA, Camacho F. Acanthosis nigricans: A new cutaneous sign in severe atopic dermatitis and Down syndrome. J Eur Acad Dermatol Venereol 2001. [DOI: 10.1046/j.0926-9959.2001.00239.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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163
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Klimopoulos S, Kounoudes C, Pantelidaki C, Skrepetou K, Papoudos M, Katsoulis H. The leser-trelat sign in association with carcinoma of the ampulla of Vater. Am J Gastroenterol 2001; 96:1623-6. [PMID: 11374711 DOI: 10.1111/j.1572-0241.2001.03807.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A 45-yr-old woman was admitted to our hospital for surgical treatment of obstructive jaundice. She was treated by a standard pancreatoduodenectomy (Whipple procedure). The biopsy of the specimen disclosed an adenocarcinoma of the ampulla of Vater. Six months before the appearance of the obstructive jaundice, she noted a sudden onset of many seborrheic keratoses on the upper part of her trunk and upper extremities. This, to our knowledge, is the first case of Leser-Trelat sign associated with adenocarcinoma of the ampulla of Vater.
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Affiliation(s)
- S Klimopoulos
- Second Surgical Department, Evangelismos Hospital, Athens, Greece
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164
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Affiliation(s)
- S Brenner
- Department of Dermatology, Tel-Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel-Aviv University, Israel
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165
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166
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Nguyen TT, Keil MF, Russell DL, Pathomvanich A, Uwaifo GI, Sebring NG, Reynolds JC, Yanovski JA. Relation of acanthosis nigricans to hyperinsulinemia and insulin sensitivity in overweight African American and white children. J Pediatr 2001; 138:474-80. [PMID: 11295708 DOI: 10.1067/mpd.2001.112657] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Acanthosis nigricans (AN) has been proposed as a reliable marker of hyperinsulinemia, but its utility for predicting hyperinsulinism has not been systematically evaluated in overweight children. We examined the relationship of AN to hyperinsulinemia and body adiposity. STUDY DESIGN One hundred thirty-nine children underwent physical examination for AN, body composition studies, an oral glucose tolerance test, and a hyperglycemic clamp. RESULTS Thirty-five children (25%) had AN. AN was more prevalent in African Americans (50.1%) than in white subjects (8.2%, P < .001). Independent of race, children with AN had greater body weight and body fat mass (P < .001); greater basal and glucose-stimulated insulin levels during oral glucose tolerance test (P < .001); greater first-phase, second-phase, and steady-state insulin levels (P < .001); and lower insulin sensitivity (P < .001) during the hyperglycemic clamp. After adjusting for body fat mass and age, none of these differences remained significant. When categorized by fasting insulin, 35% with fasting insulin levels > 20 microU/mL and 50% with fasting insulin levels > 15 microU/mL did not have AN. Eighty-eight percent of children with fasting insulin levels > or = 15 microU/mL had a body mass index SD score > or = 3.0. CONCLUSIONS AN is not a reliable marker for hyperinsulinemia in overweight children. Children with a race-, sex-, and age-specific body mass index SD scores > or = 3.0 should be screened for hyperinsulinemia, whether or not they have AN.
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Affiliation(s)
- T T Nguyen
- Unit on Growth and Obesity, Developmental Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892-1862, USA
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167
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Harman M, Akdeniz S, Cetin H, Tuzcu A. Acanthosis nigricans with vitiligo and insulin resistance. Br J Dermatol 2000; 143:899-900. [PMID: 11069486 DOI: 10.1046/j.1365-2133.2000.03801.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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168
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Bottoni U, Dianzani C, Pranteda G, Innocenzi D, De Giacomo P, Balzani A, Zampetti M, Pala S, Calvieri S. Florid cutaneous and mucosal papillomatosis with acanthosis nigricans revealing a primary lung cancer. J Eur Acad Dermatol Venereol 2000; 14:205-8. [PMID: 11032067 DOI: 10.1046/j.1468-3083.2000.00051.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This is the report of an 80-year-old patient with diffuse brownish hyperpigmentation and velvety thickening of the skin with onset 1 year before. Warty lesions on his limbs were present as well as papillomatous and verrucous lesions on his lips, mouth and eyelid conjunctivae with hyperkeratosis of the nipples. Biopsies, performed at different sites, showed histological pictures consistent with a diagnosis of acanthosis nigricans (AN) with florid cutaneous and mucosal papillomatosis. This type of AN is frequently associated with internal malignancy. In our patient serum levels of tissue polypeptide antigen, carcinoembryonic antigen, cytokeratin fragment and squamous cell carcinoma antigen were high and chest computed tomography scan indicated a large tumour infiltrating the right lung and extending to the mediastinum. Cytological examination of bronchial drainage revealed the presence of neoplastic cells, non-small cell type carcinoma. The most frequent cancer associated with malignant AN is gastric adenocarcinoma. Lung tumour has rarely been reported with AN. Malignant AN is sometimes associated with other cutaneous and mucosal warty lesions, as in our patient. These various skin and mucosal lesions are the expression of a systemic epithelial disorder and may help clinicians to suspect a malignant form of AN.
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Affiliation(s)
- U Bottoni
- Istituto di Dermatologia, Università di Roma La Sapienza, Italy.
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169
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Yeh JS, Munn SE, Plunkett TA, Harper PG, Hopster DJ, du Vivier AW. Coexistence of acanthosis nigricans and the sign of Leser-Trélat in a patient with gastric adenocarcinoma: a case report and literature review. J Am Acad Dermatol 2000; 42:357-62. [PMID: 10640933 DOI: 10.1016/s0190-9622(00)90112-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The association of acanthosis nigricans (AN) with the sign of Leser-Trélat (LT) and gastric carcinoma is rare. Our patient was a 69-year-old man, who presented with hematemesis; a stage-IV poorly differentiated, diffuse-type, adenocarcinoma of the gastric antrum was diagnosed. The AN was striking, with florid cutaneous papillomatosis that also involved the mucous membranes of the mouth and eyelids, and keratoderma. AN and the sign of LT predated tumor detection by 6 months and regressed after chemotherapy in parallel with reduction of the tumor load, demonstrating the dermatoses as paraneoplastic phenomena. The patient died 7 months after completion of chemotherapy. The coexistence of AN and the sign of LT should prompt a search for underlying malignancy. The pathogenesis of both dermatoses is discussed.
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Affiliation(s)
- J S Yeh
- Department of Dermatology, King's College Hospital, London, United Kingdom
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170
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Braun-Falco O, Plewig G, Wolff HH, Burgdorf WHC. Paraneoplastic Markers and Syndromes. Dermatology 2000. [DOI: 10.1007/978-3-642-97931-6_65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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171
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Saadi H, Lestringant GG, Nyomba BL, Bener A. Association of acanthosis nigricans with risk of diabetes and insulin resistance. Ann Saudi Med 2000; 20:69-71. [PMID: 17322752 DOI: 10.5144/0256-4947.2000.69] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- H Saadi
- Department of Internal Medicine, Faculty of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
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172
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173
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Bellus GA, Bamshad MJ, Przylepa KA, Dorst J, Lee RR, Hurko O, Jabs EW, Curry CJ, Wilcox WR, Lachman RS, Rimoin DL, Francomano CA. Severe achondroplasia with developmental delay and acanthosis nigricans (SADDAN): Phenotypic analysis of a new skeletal dysplasia caused by a Lys650Met mutation in fibroblast growth factor receptor 3. ACTA ACUST UNITED AC 1999. [DOI: 10.1002/(sici)1096-8628(19990702)85:1<53::aid-ajmg10>3.0.co;2-f] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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174
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Ramirez-Amador V, Esquivel-Pedraza L, Caballero-Mendoza E, Berumen-Campos J, Orozco-Topete R, Angeles-Angeles A. Oral manifestations as a hallmark of malignant acanthosis nigricans. J Oral Pathol Med 1999; 28:278-81. [PMID: 10426202 DOI: 10.1111/j.1600-0714.1999.tb02039.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We present a case of malignant acanthosis nigricans (AN) that initially manifested in the oral cavity. In the present report, the patient had typical clinical and histological findings of oral and esophageal AN, with subtle skin changes, associated with a gallbladder adenocarcinoma. The importance of the clinical oral examination is emphasized because the recognition of oral lesions led to the diagnosis of AN and to the following detection of the internal malignancy. Since the tumours associated with AN are highly malignant, it is of the utmost importance to recognize the skin and mucous membrane changes in adults.
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Affiliation(s)
- V Ramirez-Amador
- Universidad Autonoma Metropolitana-Xochimilco, Department of Health Care, Mexico D.F
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175
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Abstract
The appearance of skin lesions in patients with occult or obvious malignancy may be of extreme value in the detection and management of cancer because the skin is readily accessible to examination and biopsy. Examination of the skin of our patients can provide important insights into underlying malignant processes or possible complications from cancer treatment. The range of cutaneous abnormalities is wide, and include cutaneous paraneoplastic syndromes such as xanthomas, acanthosis nigricans, carcinoid syndrome, unusual erythematous eruptions such as erythema gyratum repens, and a number of genetic syndromes associated with malignancies and inherited dermatoses.
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Affiliation(s)
- S Sabir
- Hematology-Oncology Division, Hospital of the University of Pennsylvania, Philadelphia 19104, USA
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176
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Böhm M, Luger TA, Metze D. Treatment of mixed-type acanthosis nigricans with topical calcipotriol. Br J Dermatol 1998; 139:932-4. [PMID: 9893209 DOI: 10.1046/j.1365-2133.1998.02538.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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177
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Abstract
Abnormalities of pigmentation are common and frequently produce great concern in patients presenting to primary care physicians. Although many pigmentary changes arise as a consequence of inflammatory skin disorders, it is important to differentiate a primary skin disease from postinflammatory changes. Early recognition of a pigmentary disease allows the clinician to begin appropriate therapy at a stage when medical intervention may be more effective. Although many skin disorders are mainly of cosmetic concern, the condition may be devastating psychologically, requiring the clinician to be sensitive to the overall impact of the disorder and treat it accordingly.
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Affiliation(s)
- N Y Kim
- Department of Internal Medicine, St. Joseph's Hospital, Milwaukee, Wisconsin, USA
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178
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DiMartino-Nardi J. Insulin resistance in prepubertal African-American and Hispanic girls with premature adrenarche: a risk factor for polycystic ovary syndrome. Trends Endocrinol Metab 1998; 9:78-82. [PMID: 18406246 DOI: 10.1016/s1043-2760(98)00023-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Recently, the modest hyperandrogenism of premature adrenarche has been linked to the more severe hyperandrogenism of polycystic ovary syndrome (PCOS). The presence of hyperandrogenism, obesity, acanthosis nigricans, hyperinsulinism and reduced insulin sensitivity in girls with premature adrenarche and in women with PCOS suggests that the two conditions might have a common mechanism. As the early appearance of pubic hair might be the first presentation of hyperandrogenism and insulin resistance, these girls should have continued.
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Affiliation(s)
- J DiMartino-Nardi
- Department of Pediatrics, Division of Pediatric Endocrinology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10467, USA
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179
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Gorisek B, Krajnc I, Rems D, Kuhelj J. Malignant acanthosis nigricans and tripe palms in a patient with endometrial adenocarcinoma--a case report and review of literature. Gynecol Oncol 1997; 65:539-42. [PMID: 9190991 DOI: 10.1006/gyno.1997.4674] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND In the world literature, uterine carcinoma associated with paraneoplastic malignant acanthosis nigricans and tripe palms has been mentioned in two review articles. Endometrial adenocarcinoma associated with malignant acanthosis nigricans without tripe palms has been cited in three case reports, and endometrial adenocarcinoma associated with tripe palms without malignant acanthosis nigricans has been cited in one case report. We present the case of a patient with endometrial adenocarcinoma associated with acanthosis nigricans and tripe palms which we have been following for the past 7 years. METHODS Our 54-year-old patient had been operated for moderately differentiated endometrial adenocarcinoma. She had also received postoperative radiotherapy. RESULTS Three years after surgery, tripe palms and acanthosis nigricans with generalized pruritus occurred. After treatment with etretinate, the skin symptoms were somewhat mitigated while the pruritus persisted. Six years after gynecologic treatment, a solitary inguinal metastatic lymph node of endometrial carcinoma was detected. Following lymphadenectomy there was additional but not complete mitigation of skin symptoms including pruritus. CONCLUSIONS In clinical practice the association of malignant acanthosis nigricans and tripe palms with endometrial adenocarcinoma is found extremely rarely. Although the survival time of adenocarcinoma patients with malignant acanthosis nigricans is short, our patient has been treated and followed for more than 7 years.
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Affiliation(s)
- B Gorisek
- Gynecology and Perinatology Clinic, Maribor Teaching Hospital, Ljubljanska, Slovenia
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180
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Brown Verrucous Plaques in the Axilla of a 59-Year-Old Woman. J Cutan Med Surg 1997. [DOI: 10.1177/120347549700100306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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181
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Pham TH, Kaushik S, Lin BP, Jones DB. Case report: acanthosis nigricans in association with primary biliary cirrhosis: resolution after liver transplantation. J Gastroenterol Hepatol 1996; 11:1021-3. [PMID: 8985820 DOI: 10.1111/j.1440-1746.1996.tb00025.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A case is described of a 58 year old Caucasian male with primary biliary cirrhosis (PBC) who first presented with acanthosis nigricans of both axillae, skin pigmentation, which was pronounced over the posterior surface of the neck, and generalized pruritus. Following orthotopic liver transplantation for progressive liver disease, the skin pigmentation, pruritus and acanthosis nigricans resolved. It is believed that this is the first reported case of acanthosis nigricans occurring in association with PBC, a phenomenon that resolved after liver transplantation.
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Affiliation(s)
- T H Pham
- Department of Gastroenterology, Concord Repatriation General Hospital, Sydney, Australia
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182
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Abstract
The sign of Leser-Trélat is rare. It is defined as the sudden eruption of multiple seborrheic keratoses caused by a malignancy. Because both seborrheic keratoses and cancer are common in the elderly, it is not always easy to tell from the literature or in any given patient if this sign is present. In fact, its validity has been questioned. Its association with malignant acanthosis nigricans is one of several of its features that support its legitimacy as a true paraneoplastic disorder.
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Affiliation(s)
- R A Schwartz
- New Jersey Medical School, Newark 07103-2714, USA
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183
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Esperanza LE, Fenske NA. Hyperandrogenism, insulin resistance, and acanthosis nigricans (HAIR-AN) syndrome: spontaneous remission in a 15-year-old girl. J Am Acad Dermatol 1996; 34:892-7. [PMID: 8621823 DOI: 10.1016/s0190-9622(96)90074-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Acanthosis nigricans is associated with many diseases, including internal malignancies, genetic disorders, and endocrine abnormalities. Insulin resistance frequently accompanies endocrine-associated acanthosis nigricans. We describe a patient with acanthosis nigricans associated with hyperandrogenism and extreme insulin resistance that spontaneously resolved after a marked decrease in insulin receptor antibodies.
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Affiliation(s)
- L E Esperanza
- University of South Florida College of Medicine, Tampa 33612, USA
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184
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Tyler MT, Ficarra G, Silverman S, Odom RB, Regezi JA. Malignant acanthosis nigricans with florid papillary oral lesions. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1996; 81:445-9. [PMID: 8705591 DOI: 10.1016/s1079-2104(96)80021-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Acanthosis nigricans is a distinctive skin disease of importance, because it has served as an external marker for a variety of systemic disorders including endocrinopathies, and malignant tumors of internal organs. It typically appears as hyperpigmented, roughened plaques of velvety consistency and infrequently as verruca-like papillations. The oral cavity and lips can be affected by florid papillary growths. Because of its rarity and nonspecific microscopic appearance, clinical recognition of acanthosis nigricans continues to be a challenge. A case of mucocutaneous "malignant" acanthosis nigricans is presented in which pigmented skin lesions led to the discovery of a gastric adenocarcinoma, which in turn was followed by the appearance of massive oral papillomatosis. No effective treatment was found.
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Affiliation(s)
- M T Tyler
- Division of Oral Medicine and Radiology, Faculty of Dentistry, McGill University, Montreal, Québec, Canada
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185
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Abstract
A 12-year-old girl developed acanthosis nigricans due to increased levels of serum insulin. Hyperinsulinemia has been recognized as the underlying cause in most cases of acanthosis nigricans. In this paper we outline a typical clinical case with special regard to the proposed pathogenesis.
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Affiliation(s)
- K Brockow
- Department of Dermatology, Universitäts-Krankenhaus Eppendorf, Hamburg, Germany
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186
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Abstract
We report familial acanthosis nigricans affecting a 35-year-old woman, her 7-year-old son and 5-year-old daughter. Absence of the eyebrows and eyelashes was noted in this family. The mother had no axillary hair and her pubic hair was sparse. The boy also suffered from congenital heart disease and a congenital cataract in the left eye. The combination of acanthosis nigricans and ectodermal defects in this family may represent a distinct nosological entity.
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Affiliation(s)
- S D Chuang
- Department of Dermatology, National Taiwan University Hospital, Taipei, Republic of China
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187
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Stone JH, Sack KE, McCalmont TH, Connolly MK. Gottron's papules? Acanthosis nigricans. ARTHRITIS AND RHEUMATISM 1995; 38:862-5. [PMID: 7779132 DOI: 10.1002/art.1780380622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- J H Stone
- University of California, San Francisco, USA
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