Skin anomalies in acromegalic patients (Review of the practical aspects)

  • Authors:
    • Florica Sandru
    • Adelina Popa
    • Dan Nicolae Paduraru
    • Alexandru Filipescu
    • Mara Carsote
    • Adina Ghemigian
  • View Affiliations

  • Published online on: September 20, 2021     https://doi.org/10.3892/etm.2021.10765
  • Article Number: 1330
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Abstract

Acromegaly is a hormonal disorder which occurs as the result of growth hormone (GH) and insulin growth factor 1 (IGF‑1) over‑secretion; both hormones are related to skin anomalies. The skin acts as a large endocrine organ, hosting GH receptors in every cell while IGF‑1 receptors are expressed only in keratinocytes. This review is a literature review of skin anomalies found in acromegaly, either related to the disease itself or associated with related complications such as secondary diabetes mellitus, or involving associated conditions such as genetic syndromes. The following clinical points are mentioned as follows. Excessive skin and enlargement of soft tissue are due to glycosaminoglycan deposits, edema, and hyperhidrosis (mostly facial and acral). Acanthosis nigricans, a body fold dermatosis associated with insulin resistance, involves local or diffuse hyperkeratotic plaques with or without hyperpigmentation, caused by growth factors including GH/IGF‑1. Other findings include cherry angiomas (due to the effects of lipid anomalies on small vessels); oily skin features with keratosis, epidermoid cysts, crochordons, pseudo‑acanthosis nigricans; a potentially higher prevalence of varicose veins and psoriasis; low level of evidence for basal cell carcinoma, respective hidroadenitis suppurativa has been noted. In addition, complicated uncontrolled secondary diabetes mellitus (DM) may result in necrobiosis lipoidica diabeticorum, diabetic dermopathy, skin bacterial infections, dermatological complications of diabetic neuropathy, and nephropathy. Finally, associated hereditary syndromes may cause collagenomas, fibromas/angiofibromas, lipomas in multiple endocrine neoplasia type 1 (MEN1) syndrome; café‑au‑lait macules, early onset neurofibromas, juvenile xanthogranuloma (involving non‑Langerhans cell histiocytes), and intertriginous freckling in neurofibromatosis type 1. Clinical findings are differentiated from pseudo‑acromegaly such as pachydermoperiostosis. Iatrogenic rash, lipodystrophy (lipoatrophy with/without lipohypertrophy) are rarely reported after pegvisomant/somatostatin analogues or after insulin use for DM. Experiments using human cell lines have shown that GH/IGF‑1 over‑secretion are prone to epithelial‑to‑mesenchymal transition (EMT) in melanoma. In non‑acromegalic subjects, the exact role of GH/IGF‑1 in skin tumorigenesis is yet to be determined. Skin in acromegaly speaks for itself, either as the first step of disease identification or as a complication or part of a complex syndromic context.
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November-2021
Volume 22 Issue 5

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Spandidos Publications style
Sandru F, Popa A, Paduraru DN, Filipescu A, Carsote M and Ghemigian A: Skin anomalies in acromegalic patients (Review of the practical aspects). Exp Ther Med 22: 1330, 2021
APA
Sandru, F., Popa, A., Paduraru, D.N., Filipescu, A., Carsote, M., & Ghemigian, A. (2021). Skin anomalies in acromegalic patients (Review of the practical aspects). Experimental and Therapeutic Medicine, 22, 1330. https://doi.org/10.3892/etm.2021.10765
MLA
Sandru, F., Popa, A., Paduraru, D. N., Filipescu, A., Carsote, M., Ghemigian, A."Skin anomalies in acromegalic patients (Review of the practical aspects)". Experimental and Therapeutic Medicine 22.5 (2021): 1330.
Chicago
Sandru, F., Popa, A., Paduraru, D. N., Filipescu, A., Carsote, M., Ghemigian, A."Skin anomalies in acromegalic patients (Review of the practical aspects)". Experimental and Therapeutic Medicine 22, no. 5 (2021): 1330. https://doi.org/10.3892/etm.2021.10765