Acanthosis Nigricans and Insulin Resistance Associated With Hypothyroidism

Ober, K. Patrick

doi:10.1001/archderm.1985.01660020087024

Cited by 31 publications

(15 citation statements)

References 25 publications

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“…This finding is in concert with those of Ober, 29 who reported AN and insulin resistance in association with hypothyroidism. There was no significant correlation between FT 4 and TSH on the one hand and BMI (r = 0.11 and 0.19 respectively) and C-peptide level (r = 0.14 and 0.14 respectively) on the other hand.…”

Section: Discussionsupporting

confidence: 89%

Prevalence and Significance of Acanthosis Nigricans in Children and Adolescents

et al. 1996

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Acanthosis nigricans (AN) develops commonly in obese adults, yet its prevalence and metabolic significance in children and adolescents have not been determined. To address these issues, 100 obese children and adolescents enrolled in the obesity clinic at the Royal Hospital, Muscat, Oman, were chosen at random and examined. AN was observed in 43 of the study children (43%). The frequency and severity of AN increased significantly with increasing body mass index (BMI) in these children. Twenty patients with obesity and AN and 20 age-matched nonacanthotic obese children, randomly selected from the study children, were investigated. Their oral glucose tolerance and serum C-peptide responses to IV glucagon were evaluated. Circulating concentrations of free thyroxine (FT 4 ), TSH, basal and ACTH-stimulated Cortisol, testosterone, leutinizing hormone (LH), folliclestimulating hormone (FSH), and prolactin were measured by radioimmunoassay (RIA). Children with AN exhibited higher basal and glucagon-stimulated C-peptide concentrations than the nonacanthotic obese group. Two hours after the oral load of glucose (1.75 g/kg), serum glucose concentration (6.3 ±1.4 mmol/L) was higher in the acanthotic group versus the nonacanthotic group (5.2 ± 0.8 mmol/L). Impaired glucose tolerance was detected in two children with AN (10%), and in none of the nonacanthotic controls. Hypothyroidism was diagnosed in two (10%) children with AN (TSH = 109 and 18 mIU/mL and FT 4 = 4.6 and 13.5 pmol/L respectively), while all the nonacanthotic children were euthyroid. Serum testosterone concentration was insignificantly lower in the acanthotic group (6.5 ± 3.9 ng/dL) versus the nonacanthotic children (8.3 ± 4.5 ng/dL). Basal serum LH, FSH and prolactin concentrations and basal and ACTH-stimulated Cortisol levels did not differ between the two study groups. Plasma triglyceride concentration was significantly higher in the acanthotic group (1.43 ± 0.5 mmol/L) versus the nonacanthotic group (1.05 ± 0.45 mmol/L), and was correlated significantly with BMI (r = 0.466, P < 0.05). In conclusion, obesity is a significant risk factor for the development of AN in children. AN is a reliable skin marker of hyperinsulinemia in obese children and adolescents. The prevalence of impaired glucose tolerance (10%) and primary hypothyroidism (10%) appears to be higher in obese acanthotic children than in those without AN.

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Section: Discussionsupporting

confidence: 89%

Prevalence and Significance of Acanthosis Nigricans in Children and Adolescents

et al. 1996

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“…The elevated insulin levels in hypothyroid animals may have at least two underlying causes. The increased adiposity that is generally associated with the hypothyroid state decreases the insulin sensitivity of peripheral tissues, thereby increasing insulin requirement, which is met by increased insulin secretion by the pancreas (29,30). Alternatively, a direct decrease in insulin sensitivity in hypothyroidism, as has been suggested previously (31), may contribute to the elevated circulating insulin levels.…”

Section: Discussionmentioning

confidence: 99%

Effects of thyroid status on insulin-like growth factor-I, growth hormone and insulin are modified by food intake

Morovat

Dauncey

1998

European Journal of Endocrinology

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Understanding the interactions between metabolic signals that regulate insulin-like growth factor-I (IGF-I) is crucial to a recognition of mechanisms that control mammalian growth. Thyroid hormones (THs) are essential for normal growth and development, and it has been suggested previously that they can modify circulating IGF-I concentrations. However, the fact that THs influence food intake, which can itself affect plasma IGF-I levels, has been ignored in previous studies. We have therefore investigated the effects of thyroid status on plasma IGF-I under conditions of controlled food intake in young growing pigs. Circulating IGF-I, growth hormone (GH) and insulin levels, were studied in hypo-and hyperthyroid animals on the same level of food intake as euthyroid controls. In addition, a separate group of hyperthyroid animals was given double the amount of food, in order to assess the influence of increased food intake, as would occur naturally in the hyperthyroid state. Hypothyroid animals and hyperthyroids with extra food had the greatest increase in body weight over the 3 weeks of treatment. These two groups had significantly higher circulating IGF-I and insulin concentrations than either the euthyroid or hyperthyroid animals on the same food intake. Integration of GH concentrations from samples taken every 20 min over a 9 h period showed that, by contrast with IGF-I and insulin levels, GH levels were significantly lower in hypothyroids and hyperthyroids on extra food compared with the euthyroids and the hyperthyroids on the same food intake. We conclude that the effects of thyroid status on IGF-I are mediated in part by the effects that THs have on energy balance, and that nutritional signals are capable of modifying the influence of thyroid status per se on circulating IGF-I concentrations. European Journal of Endocrinology 138 95-103

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“…1997; 17(6): [651][652][653] The association of acanthosis nigricans (AN) with malignant tumors, obesity, insulin resistance and diabetes, hyperandrogenism, and other endocrinopathies has received the attention of many investigators for the past 100 years. [1][2][3][4][5][6][7][8][9][10][11][12][13] Most malignant tumors reported in the earlier literature were gastrointestinal. Recent literature, however, points to more association of malignancies with AN involvement of eyelids, conjunctiva 2,7,14-17 and oral cavity, palate or esophagus.…”

mentioning

confidence: 99%

Acanthosis Nigricans: A New Analysis of Associated Endocrine and Malignant Disorders

Misha'l

1997

Ann Saudi Med

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AA Mishal, Acanthosis Nigricans: A New Analysis of Associated Endocrine and Malignant Disorders. 1997; 17(6): [651][652][653] The association of acanthosis nigricans (AN) with malignant tumors, obesity, insulin resistance and diabetes, hyperandrogenism, and other endocrinopathies has received the attention of many investigators for the past 100 years. [1][2][3][4][5][6][7][8][9][10][11][12][13] Most malignant tumors reported in the earlier literature were gastrointestinal. Recent literature, however, points to more association of malignancies with AN involvement of eyelids, conjunctiva 2,7,14-17 and oral cavity, palate or esophagus. 3,18,19 Insulin resistance is considered to be the underlying pathomechanism of AN by many workers. 4,[6][7][8]11 Different types of insulin receptor gene mutations have been described recently. 20,21 Other investigators described excess insulin binding to insulin-like growth factor receptors, 22 thus inducing various forms of growth effects. One report established certain keratin patterns in AN 23 which could have contributed to the etiology of skin lesions of AN, and another described acromegaly-like features in some patients with AN and hyperinsulinemia. 4 Some or all of these mechanisms, as well as others not yet established, could result in insulin resistance, hyperinsulinemia with its growth-promoting influences on the skin, ovaries and possibly other tissues. Other endocrinopathies associated with AN, such as thyroid, 13,14,24 pituitary 12,25,26 and adrenal disorders, 27,28 were frequently reported, but no clear pathomechanisms were established in these reports. This is a cross-sectional observation study of the prevalence of associated endocrinopathies with AN in certain age and sex groups, along with an attempt to explain such associations. The lack of malignant tumors in this series is also discussed. Materials and MethodsThe study group included 138 patients (95 females and 43 males), ranging in age from three to 62 years. They were followed between three months and 10 years in our endocrinology out-patient clinics.The patients were divided into three subgroups, taking into consideration the average ages of puberty and menopause in females who represented the majority of patients in this series: 1) under 15 years; 2) between 15-45 years; and 3) over 45 years of age.All patients had acanthosis nigricans, with velvety, hyperpigmented thickening of skin over the nape of the neck, with or without involvement of axillae and other flexure areas. Papillomatous formation was present in most cases. No eyelids, conjunctiva or oral cavity involvement with AN was found in any of these patients.Diagnosis of associated disorders was established by history, physical examination, body mass index (BMI), hormone measurements by radioimmunoassays of thyroid function tests, free testosterone, 17 (OH) progesterone, dehydroepiandrosterone sulfate (DHEAS), Cortisol, gonadotropins, prolactin, immunoreactive insulin, and Cpeptide levels. Further work-up of polycystic ovary syndrome included...

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Acanthosis Nigricans and Insulin Resistance Associated With Hypothyroidism

Cited by 31 publications

References 25 publications

Prevalence and Significance of Acanthosis Nigricans in Children and Adolescents

Prevalence and Significance of Acanthosis Nigricans in Children and Adolescents

Effects of thyroid status on insulin-like growth factor-I, growth hormone and insulin are modified by food intake

Acanthosis Nigricans: A New Analysis of Associated Endocrine and Malignant Disorders

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