Skin Changes, Thickness May Aid in Early Acromelagy Detection

Using dermoscopy and routine assessments, physicians may be able to more easily detect signs of cutaneous-involved acromelagy.

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In a recent case-control study,¹ researchers sought to investigate clinical cutaneous manifestations of the rare neuroendocrine disease which involves an overproduction of the body’s growth hormone. They cited a lack of general understanding of the disease’s cutaneous involvement as their motivation for the study, noting that insufficient understanding of the condition may delay diagnosis by up to 10 years on average. Furthermore, understanding and research are particularly lacking in Asian populations.

Researchers included patients diagnosed with acromelagy at a neurosurgery department from July 2021 to March 2022 as prospective participants. Included participants met acromelagy diagnosis criteria established by the Endocrine Society Clinical Guideline following assessment, hormone level analysis, and radiological testing. Furthermore, all prospective participants were required to have 3 months prior to their hospital admission clear of any medical or surgical treatment.

37 participants made up the study’s acromelagy group, while 26 patients were included in the control group. All participants were Asian and had Fitzpatrick skin types III or IV.

Patients were excluded from participation if they had a prior history of systemic diseases involving cutaneous manifestations, a history of medication use that may have impacted the skin (i.e. chemotherapy, cortical steroids), major skin disorders such as dermatitis or psoriasis in combination with pituitary adenoma, or an incomplete medical history.

Upon diagnosis and admission, researchers assessed patients for several factors, including adenoma size, disease duration, and numerous hormone levels, through numerous tests.

Dermoscopic imaging was completed, capturing superficial skin features at various areas of the body, including the face, limbs, extremities, abdomen, back, and anywhere else clinically relevant. Using a 20 MHz high-frequency ultrasound system, researchers assessed and measured participants’ skin thickness, particularly in their back. After an 8-hour fasting period, researchers also collected patient blood samples to analyze specific hormone levels such as GH, IGF-1, and ULN.

As a result of the analysis and data collection, researchers found that certain characteristic skin manifestations of acromelagy were significantly more prevalent or noticeable in the case group, or in participants in the acromelagy group. These included skin thickening, face coarsening, and enlarged hands or feet. Other statistically significant skin findings included acne-like lesions, facial erythema, and patterns of hyperpigmentation.

Researchers also made note of correlating symptoms of a cutaneous nature, including excessive seborrhea, enlarged pores, hyperhidrosis, hypertrichosis, and hair thickening.

Additionally, acromelagic patients had an average skin thickness of 4.10 ± 0.48 mm, while control group patients had an average skin thickness of 3.55 ± 0.52 mm. However, researchers did not find a correlation between skin thickness and disease duration, adenoma size, and hormone levels.

“To the best of our knowledge, this is the first study applying dermoscopy in the evaluation of acromegaly,” study authors wrote. “The obvious discrepancy in the skin symptoms, the dermoscopic characteristics and ultrasonic skin thickness between patients and controls are valuable for the early detection and accurate assessment of acromegaly. Likewise, this article provides dermatologists, neurosurgeons and endocrinologists with a new appreciation of acromegalic skin. Dermatologists engaging patients with such skin signs therefore can be vigilant about the potential hormone elevation and apply skin imaging evaluation to confirm the concerns and reduce delayed diagnosis.”

Reference

1. Wang Y, Guo X, Liu J, Xing B. Skin manifestations and submacroscopical features of acromegaly: A case-control study using dermoscopy and high-frequency ultrasound. Skin Research and Technol. 2023;29(4). doi:https://doi.org/10.1111/srt.13319