Matsuoka L Y, Wortsman J, Gavin J R, Goldman J
Department of Medicine, Southern Illinois University, Springfield 62794-9230.
Am J Med. 1987 Oct;83(4):719-25. doi: 10.1016/0002-9343(87)90903-x.
Acanthosis nigricans is a marker for disorders of insulin action, endocrine abnormalities, and cancer of internal organs. To evaluate the clinical significance of this marker the systemic alterations and clinical features of 26 patients with acanthosis nigricans seen at two institutions were reviewed. Most subjects affected by acanthosis nigricans were female (20 patients), Caucasian (22 patients), in the third decade of life (13 patients), and overweight (24 patients greater than 120 percent ideal body weight). Gonadal disease, present in 17 patients, was expressed as polycystic ovary syndrome (11 cases), disorders of prolactin secretion (two cases, one with polycystic ovary syndrome), streak gonads (one case), and hypogonadism of the male (four cases). Thyroid disease and tinea versicolor were present in four patients each. Three patients were receiving insulin therapy for diabetes mellitus, and in two additional patients diabetes mellitus was detected during the diagnostic workup. All patients had elevated fasting insulin levels; most of them also had an exaggerated insulin response to a glucose load. Two of 18 patients tested had antibodies against the insulin receptor in the circulation. Skin biopsy of acanthosis nigricans lesions from all 26 patients showed a typical pattern of hyperkeratosis, acanthosis, and epidermal papillomatosis. Colloidal iron staining showed glycosaminoglycan infiltration of the papillary dermis (21 of 21 cases), consisting mainly of hyaluronic acid. It is concluded that: (1) hyperinsulinenemia and local dermal glycosaminoglycan deposition are regular features in acanthosis nigricans and (2) patients with acanthosis nigricans should be screened for diabetes mellitus, gonadal disease, and hypothyroidism.
黑棘皮病是胰岛素作用紊乱、内分泌异常及内脏器官癌症的一个标志物。为评估该标志物的临床意义，回顾了在两家机构就诊的26例黑棘皮病患者的全身改变及临床特征。大多数患黑棘皮病的受试者为女性（20例）、白种人（22例）、处于人生第三个十年（13例）且超重（24例超过理想体重的120%）。17例患者存在性腺疾病，表现为多囊卵巢综合征（11例）、催乳素分泌紊乱（2例，其中1例合并多囊卵巢综合征）、条索状性腺（1例）及男性性腺功能减退（4例）。甲状腺疾病和花斑癣各有4例患者存在。3例患者因糖尿病接受胰岛素治疗，另有2例患者在诊断检查期间被检测出患有糖尿病。所有患者空腹胰岛素水平均升高；大多数患者对葡萄糖负荷的胰岛素反应也增强。18例接受检测的患者中有2例循环中存在抗胰岛素受体抗体。对所有26例患者的黑棘皮病皮损进行皮肤活检，均显示出角化过度、棘层肥厚和表皮乳头瘤病的典型模式。胶体铁染色显示乳头真皮有糖胺聚糖浸润（21例中的21例），主要由透明质酸组成。得出以下结论：（1）高胰岛素血症和局部真皮糖胺聚糖沉积是黑棘皮病的常见特征；（2）应对黑棘皮病患者进行糖尿病、性腺疾病和甲状腺功能减退的筛查。
