Manifestaciones dermatológicas y enfermedades concomitantes en pacientes con acromegalia o gigantismo

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Artículo de investigación
Rev Asoc Colomb Dermatol. 2019; 27 : 2 (abril - junio), 98-107

Manifestaciones dermatológicas y enfermedades concomitantes en pacientes con acromegalia o gigantismo

Dermatologic manifestations and comorbidities in patients with acromegaly or gigantism
Autor(es): 
Wilson Galvis Franco
wilsongalvisf@yahoo.com
Médico dermatólogo; docente, Universidad de Antioquia, Medellín
Humberto Ignacio Franco
Médico endocrinólogo; docente, Universidad de Caldas, Manizales
Alín Abreu-Lomba
Médico endocrinólogo, Centro Médico Imbanaco, Cali
Consuelo VélezÁlvarez
Enfermera, epidemióloga, Ph. D. en Salud Pública; docente, Universidad de Caldas, Manizales, Colombia
Resumen: 

 Introducción: La acromegalia y el gigantismo son enfermedades causadas por la producción excesiva de hormona de crecimiento. En la mayoría de los pacientes que presentan estas enfermedades se describen cambios cutáneos, al igual que enfermedades concomitantes que aumentan su morbimortalidad.

Objetivo: Describir las manifestaciones dermatológicas y las enfermedades con­comitantes, en pacientes con acromegalia o gigantismo.

Métodos: Se desarrolló un estudio descriptivo y transversal, en el cual se eva­luaron y describieron las características dermatológicas y enfermedades sisté­micas asociadas, en pacientes con acromegalia o gigantismo valorados en la con­sulta de endocrinología de las ciudades de Manizales y Armenia, en el periodo de abril y mayo de 2013.

Resultados: Se describen los hallazgos dermatológicos y comorbilidades en 20 pacientes con acromegalia y 2 con gigantismo, todos ellos con adenoma hipofi­siario. Se encontró engrosamiento de la piel y el cuero cabelludo en 77.3 % de los casos, agrandamiento distal de extremidades (acral) en 95.5 %, agrandamiento de nariz en 81.8 %, agrandamiento de orejas en 27.3 %, agrandamiento de labios en 50 %, macroglosia en 54.5 %, prominencia frontal en 63.6 %, y prognatismo y mala oclusión en 68.2 %, entre otras manifestaciones clínicas. Se encontraron en­fermedades sistémicas asociadas en 63.6 %, principalmente, hipertensión arterial (50 %), diabetes (27.3 %) y dislipidemia (45.5 %).

Conclusión: La población analizada en este estudio no difiere de otras descritas en la literatura médica mundial. Sin embargo, los hallazgos corroboran la gran frecuencia de manifestaciones dermatológicas y comorbilidades y su importancia al momento del enfoque clínico, ya que permiten sospechar la enfermedad y pueden llevar a un diagnóstico temprano que impacte positivamente en su mor­bimortalidad.

Palabras clave: 
acromegalia, gigantismo, manifestaciones cutáneas, piel.

Summary: 

Introduction: Acromegaly and gigantism are di­seases caused by an excessive production of growth hormone. Most of patients who suffer these con­ditions are affected with skin changes, as well as comorbidities increasing their morbidity and mor­tality.

Objective: To describe the dermatological mani­festations and associated comorbidities in patients with acromegaly and gigantism.

Methods: A descriptive cross-sectional study was developed, which evaluated and described the der­matological features and systemic diseases asso­ciated in patients with acromegaly and gigantism valued in endocrinology in Manizales and Armenia in the the period April to May, 2013.

Results: The dermatological findings and asso­ciated comorbidities in 20 patients with acromegaly and 2 with gigantism are described; a pituitary ade­noma was demonstrated in all of them. The findings were as follows: thickening of skin and scalp , 77.3% of patients; acral enlargement, 95.5%; enlarged nose , 81.8%; enlarged ears , 27.3%; enlarged lips, 50%; macroglossia, 54.5%; likewise, frontal bos­sing was found in 63.6%, prognathism and maloc­clusion in 68.2%, among others. Systemic diseases were associated in 63.6%, mainly hypertension in 50%, diabetes in 27.3% and dyslipidemia in 45.5%.

Conclusion: The population analyzed in this study does not differ from that described in medical lite­rature; the findings support the high frequency of dermatological manifestations and associated co­morbidities in these patients and its importance at the time of clinical approach, allowing to suspect the disease and may lead to an early diagnosis that will impact positively morbidity and mortality.

Key words: 
Acromegaly, gigantism, skin manifestations, skin.
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Referencias

 

  1. Adelman DT, Liebert K, Nachtigall LB, Lamerson M, Bakker B. Acromegaly: The disease, its impact on patients, and managing the burden of long-term treatment. Int J Gen Med. 2013;6:31-8.
  2. Chanson P, Salenave S. Acromegaly. Orphanet J Rare Dis. 2008;3:1-17.
  3. Holdaway IM, Rajasoorya C. Epidemiology of acro­megaly. Pituitary. 1999;2:29-41.
  4. Daly AF, Rixhon M, Adam C, Dempegioti A, Ticho­mirowa MA, Beckers A. High prevalence of pitui­tary adenomas: Across-sectional study in the pro­vince of Liege, Belgium. J Clin Endocrinol Metab. 2006;91:4769-75.
  5. Ezzat S, Forster MJ, Berchtold P, Redelmeier DA, Boerlin V, Harris AG. Acromegaly. Clinical and bio­chemical features in 500 patients. Medicine (Balti­more). 1994;73:233-40.
  6. Resende M, Bolfi F, dos Santos-Nunes V, Amante-Miot H. Prevalence of dermatologic disorders in 15 patients with acromegaly. An Bras Dermatol. 2012;87:166-8.
  7. Kalus A, Chien A, Olerud J. Diabetes mellitus and other endocrine diseases. Acromegaly. In: Klaus Wolff, Lowell Goldsmith, Stephen Katz, Barbara Gilchrest, Amy Paller. Fitzpatrick´s Dermatology in General Medicine. 7th. Edition. McGraw Hill companies. pag. 1461-84.
  8. Ben-Shlomo A, Melmed S. Skin manifestations in acromegaly. Clin Dermatol. 2006;24:256-9.
  9. Centurión SA, Schwartz RA. Cutaneous signs of acromegaly. Int J Dermatol. 2002,41:631-4.
  10. Dahbar M, Danilowicz K,Malavela M, Velásquez D, Allevato M, Cabrera H, et al. Manifestaciones cutáneas en la acromegalia. Dermatol Argent. 2009;15:186-90.
  11. Lioté F, Orcel P. Osteoarticular disorders of en­docrine origin. Best Pract Res Clin Rheumatol. 2000;14:251-76.
  12. Lieberman SA, Björkengren AG, Hoffman AR. Rheumatologic and skeletal changes in acrome­galy. Endocrinol Metab Clin North Am. 1992;21:615-31.
  13. Kamenicky P, Viengchareun S, Blanchard A, Me­duri G, Zizzari P, Imbert-Teboul M, et al. Epithelial sodium channel is a key mediator of growth hor­mone-induced sodium retention in acromegaly. Endocrinology. 2008;149:3294-305.
  14. Mosca S, Paolillo S, Colao A, Bossone E, Cittadini A, IudiceFL, et al. Cardiovascular involvement in patients affected by acromegaly: An appraisal. Int J Cardiol. 2013;167:1712-8.
  15. Attal P, Chanson P. Endocrine aspects of obs­tructive sleep apnea. J Clin Endocrinol Metab. 2010;95:483-95.
  16. Jenkins PJ, Sohaib SA, Akker S, Phillips RR, Spi­llane K, Wass JA, et al. The pathology of median neuropathy in acromegaly. Ann Intern Med. 2000;133:197-201.
  17. Ruiz R, Durán EG, Arellano SA, Sánchez V, Mo­reno OT, Mendoza F. Acromegalia. Med Int Mex. 2009;25:468-80.
  18. Berg C, Petersenn S, Lahner H, Herrmann BL, Bu­chfelder M, Droste M, et al. Cardiovascular risk fac­tors in patients with uncontrolled and long-term acromegaly: Comparison with matched data from the general population and the effect of disease control. J Clin Endocrinol Metab. 2010;95:3648-56.
  19. Dutta P, Bhansali A, Vaiphei K, Dutta U, Ravi Kumar P, Masoodi S, et al. Colonic neoplasia in acromegaly: Increased proliferation or deceased apoptosis? Pituitary. 2012;15:166-73.
  20. Andersen M. Management of endocrine disease: GH excess: Diagnosis and medical therapy. Eur J Endocrinol. 2013;170:31-41.
  21. Rúa C, Latorre G, Campuzano G. Diagnóstico de acromegalia. Medicina y Laboratorio. 2011;17:511-531.
  22. Kannan S, Kennedy L. Diagnosis of acrome­galy: State of the art. Expert Opin Med Diagn. 2013;7:443-53.
  23. Scacchi M, Cavagnini F. Acromegaly. Pituitary. 2006;9:297-303.
  24. Bianchi A, Valentini F, Iuorio R, Poggi M, Baldelli R, PasseriM, et al. Long-term treatment of soma¬tostatin analog-refractory growth hormone-secre¬ting pituitary tumors with pegvisomant alone or combined with long-acting somatostatin analogs: A retrospective analysis of clinical practice and outcomes. J ExpClin Cancer Res. 2013;32:1-11.
  25. Pita-Gutiérrez F, Pertega-Díaz S, Pita-Fernández S, Pena L, Lugo G, Sangiao-Alvarellos S, et al. Place of preoperative treatment of acromegaly with somatostatin analog on surgical outcome: A systematic review and meta-analysis. PLoS One. 2013;8:e61523.
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