Matsuoka L Y, Wortsman J, Kupchella C E, Eng A, Dietrich J E
Arch Intern Med. 1982 Oct;142(10):1820-3.
We evaluated the pathogenesis of skin thickening in three patients with acromegaly. Growth hormone levels were normal in one patient and were elevated in two patients. Skin biopsy specimens were obtained from the forearm. Hematoxylineosin staining showed slight epidermal thinning and, in two of the patients, a small increase in the number of fibroblasts. Selective stains for collagen, elastic, and reticular fibers disclosed normal connective tissue. The most striking abnormality was increased glycosaminoglycan deposition on the slides stained with colloidal iron. Glycosaminoglycan infiltration occurred mostly in the papillary and upper reticular dermis and was not directly related to the simultaneous growth hormone levels. Tissue digestion with specific enzymes identified hyaluronic acid, chondroitin-4- and 6-sulfate, and dermatan sulfate as the most prominent glycosaminoglycans in the dermis. The skin ultrastructure appeared to be preserved on electron microscopy. We conclude that cutaneous mucinoses is the main cause for the thickening of the skin in acromegaly.
我们评估了3例肢端肥大症患者皮肤增厚的发病机制。其中1例患者生长激素水平正常，2例患者生长激素水平升高。从前臂获取皮肤活检标本。苏木精-伊红染色显示表皮轻度变薄，2例患者的成纤维细胞数量略有增加。胶原纤维、弹性纤维和网状纤维的选择性染色显示结缔组织正常。最显著的异常是在胶体铁染色的玻片上糖胺聚糖沉积增加。糖胺聚糖浸润主要发生在乳头层和真皮上部网状层，与同时期的生长激素水平无直接关系。用特定酶进行组织消化鉴定出透明质酸、硫酸软骨素-4和-6以及硫酸皮肤素是真皮中最主要的糖胺聚糖。电子显微镜下皮肤超微结构似乎保持完整。我们得出结论，皮肤粘蛋白沉积症是肢端肥大症患者皮肤增厚的主要原因。
