ABSTRACT
RESUMO Objetivo: Avaliar em um grupo de crianças e adolescentes com obesidade e sobrepeso a presença ou não de acantose nigricans e sua associação com alterações metabólicas. Métodos: Estudo transversal envolvendo 161 indivíduos com excesso de peso, que foram divididos em dois grupos, segundo a presença ou não de acantose nigricans, e nos quais foram obtidas medidas antropométricas (índice de massa corporal, pregas cutâneas, circunferência abdominal), pressão arterial, análises laboratoriais (glicemia de jejum, insulina, perfil lipídico, triglicerídeos, ácido úrico, transaminases) e o índice homeostasis model assessment. Resultados: O grupo com acantose nigricans representou 51,5% da amostra. A média de idade foi semelhante entre os grupos. O grupo com acantose nigricans apresentou maiores índice de massa corporal, escore Z do índice de massa corporal, percentual de gordura corporal, circunferência abdominal (p<0,0001) e pressão arterial sistólica (p=0,006) e diastólica (p=0,002). Não houve diferença significativa na análise do perfil lipídico, exceto o colesterol de alta densidade, que foi menor (p=0,003) no grupo com acantose. Já o ácido úrico (p<0,0001), a glicemia de jejum (p=0,006), a insulina (p<0,0001), a transaminase glutâmica oxalacética (p<0,0001) e o índice homeostasis model assessment (p<0,0001) foram significativamente maiores no grupo com acantose nigricans. Conclusões: Acantose nigricans em crianças e adolescentes com sobrepeso e obesidade esteve associada à elevação dos índices de adiposidade corporal, pressão arterial, insulina e homeostasis model assessment, indicando-a como marcador clínico associado à síndrome metabólica.
ABSTRACT Objective: To evaluate the presence or absence of acanthosis nigricans and its association with metabolic alterations in a group of obese and overweight children and adolescents. Methods: A cross sectional study of 161 overweight children and adolescents, who were divided into two groups, according to presence or absence of acanthosis nigricans. Anthropometric measurements (body mass index, skinfolds, abdominal circumference), blood pressure, laboratory tests (fasting glycemia, insulin, lipid profile, triglycerides, uric acid, transaminases) and homeostasis model assessment index. Results: The acanthosis nigricans group represented 51.5% of the sample. The mean age was similar between groups. The group with acanthosis nigricans presented higher body mass index, Z score of body mass index, body fat percentage, abdominal circumference (p<0.0001), systolic (p=0.006) and diastolic blood pressure (p=0.002). There was no significant difference in the analysis of lipid profile, except for the high-density cholesterol, which was lower (p=0.003) in the group with acanthosis. On the other hand, uric acid (p<0.0001), fasting glycemia (p=0.006), insulin (p<0.0001), glutamic oxalacetic transaminase (p<0.0001), and homeostasis model assessment index (p<0.0001) were significantly higher in the group with acanthosis nigricans. Conclusions: Acanthosis nigricans in overweight and obese children and adolescents is associated with elevation of body fat, blood pressure, insulin and homeostasis model assessment index, indicating that it is a clinical marker associated with the metabolic syndrome.
Subject(s)
Humans , Male , Female , Child , Adolescent , Metabolic Syndrome/complications , Overweight/complications , Pediatric Obesity/complications , Acanthosis Nigricans/complications , Cross-Sectional Studies , Risk FactorsABSTRACT
Introduction: Obesity-related comorbidities are present in young obese children, providing a platform for early adult cardiovascular disorders. Objectives: To compare and correlate markers of adiposity to metabolic disturbances, vascular and cardiac morphology in a European pediatric obese cohort. Methods: We carried out an observational and transversal analysis in a cohort consisting of 121 obese children of both sexes, between the ages of 6 and 17 years. The control group consisted of 40 children with normal body mass index within the same age range. Markers of adiposity, plasma lipids and lipoproteins, homeostasis model assessment-insulin resistance, common carotid artery intima-media thickness and left ventricular diameters were analyzed. Results: There were statistically significant differences between the control and obese groups for the variables analyzed, all higher in the obese group, except for age, high-density lipoprotein cholesterol and adiponectin, higher in the control group. In the obese group, body mass index was directly correlated to left ventricular mass (r=0.542; p=0.001), the homeostasis model assessment-insulin resistance (r=0.378; p=<0.001) and mean common carotid artery intima-media thickness (r=0.378; p=<0.001). In that same group, insulin resistance was present in 38.1%, 12.5% had a combined dyslipidemic pattern, and eccentric hypertrophy was the most common left ventricular geometric pattern. Conclusions: These results suggest that these markers may be used in clinical practice to stratify cardiovascular risk, as well as to assess the impact of weight control programs. .
Fundamento: As comorbidades relacionadas com a obesidade encontram-se patentes em crianças jovens obesas e são, potencialmente, um ponto de partida para as doenças cardiovasculares em adultos jovens. Objetivos: Comparar e correlacionar marcadores de adiposidade com distúrbios metabólicos e alterações cardiovasculares numa coorte de crianças obesas europeias. Métodos: Estudo observacional e transversal de uma coorte composta por 121 crianças obesas de ambos os gêneros, entre 6 e 17 anos de idade. O grupo controle incluiu 40 crianças com índice de massa corporal normal dentro da mesma faixa etária. Analisamos marcadores de adiposidade, lípides e lipoproteínas, o índice de insulino-resistência, a espessura da camada íntima-média da artéria carótida comum e os diâmetros do ventrículo esquerdo. Resultados: Observamos diferenças significativas entre os grupos controle e obeso para todos os parâmetros em análise, com todos os valores mais elevados no grupo obeso, exceto a idade, a lipoproteína de alta densidade e a adiponectina, superiores no grupo controle. No grupo obeso, o índice de massa corporal correlacionou‑se diretamente com a massa ventricular esquerda (r=0,542; p=0,001), com o índice de insulino-resistência (r = 0,378; p = < 0,001) e com a espessura da camada íntima-média da artéria carótida comum (r = 0,378; p = <0,001). Ainda no grupo obeso, 38,1% tinham insulino-resistência, 12,5% apresentavam um padrão de dislipidemia combinada, e hipertrofia excêntrica foi a forma geométrica ventricular mais observada. Conclusões: Os resultados obtidos sugerem que os marcadores analizados podem ser utilizados para aferir risco cardiovascular, assim como para avaliar o impacto analítico e morfológico dos programas de redução de peso. .
Subject(s)
Adolescent , Child , Female , Humans , Male , Adiposity , Dyslipidemias , Insulin Resistance , Pediatric Obesity , Age Factors , Acanthosis Nigricans/complications , Acanthosis Nigricans/diagnosis , Adiponectin/blood , Body Mass Index , Biomarkers/blood , Carotid Intima-Media Thickness , Case-Control Studies , Cross-Sectional Studies , Cardiovascular Diseases/etiology , Cardiovascular Diseases/prevention & control , Dyslipidemias/blood , Dyslipidemias/complications , Hypertrophy, Left Ventricular/pathology , Leptin/blood , Lipoproteins/blood , Pediatric Obesity/blood , Pediatric Obesity/complications , Risk Factors , Sex Factors , Waist CircumferenceABSTRACT
La lipodistrofia parcial familiar de tipo1 (LPF 1) es un síndrome caracterizado por la pérdida parcial de grasa subcutánea en extremidades con distribución incrementada de la misma en rostro, cuello y tronco. Es una identidad familiar aunque hay casos espontáneos. Hasta ahora no se conoce mutación responsable. Se debe realizar diagnóstico diferencial con el síndrome de Cushing. Es un síndrome poco frecuente y en oportunidades se llega al diagnóstico cuando los pacientes presentan complicaciones cardiovasculares o afectación pancreática como consecuencia de una grave alteración metabólica. Se presenta el caso de una paciente de 45 años con diabetes mellitus desde los 20 años de edad, mal control glucémico (HbA1c: 11.7%) e hipertrigliceridemia (TG: 3000 mg/dl), índice de masa corporal (IMC): 38, extremidades adelgazadas, pérdida de grasa subcutánea en glúteos, sobreelevación de pliegue por encima de los mismos, venas prominentes en miembros inferiores, cara de luna llena y marcada acantosis nigricans, hipertensión (TA: 150/100 mm Hg) y medidas de pliegues subcutáneos disminuidos. El dosaje de leptina fue 16.8 mg/ml. El estudio genético para gen LMNA fue negativo. Se instauraron medidas de cambio de estilo de vida, tratamiento con fenofibrato, insulina premezcla 50/50 y enalapril, obteniéndose una franca mejoría clínica, de la HbA1c (7.8%) y de los TG (243 mg/dl).
Familial partial lipodystrophy (FPL) type 1 is a syndrome characterized by loss of subcutaneous fat in arms and legs and an excess of body fat in face, neck, and torso. This rare syndrome is usually diagnosed when patients present cardiovascular complications or pancreatitis due to the severe metabolic abnormalities. Here we present the case of a 45 year old diabetic female without any pathological family history, a poor glycemic control (HbA1c 11.7%), hypertriglideridemia (3000 mg/dl), a body mass index (BMI) of 38, thin limbs, subcutaneous fat loss in gluteal area and ledge of fat above them, prominent veins in lower extremities, moon face, and acanthosis nigricans; as well as hypertension (150/100 mmHg) and subcutaneous folds measuring less than average were observed. Hypercortisolism was discarded and leptin levels were measured (16.8 mg/ml, VR: BMI > 30: 50 mg/ml). Due to these clinical and biochemical manifestations, and low leptin levels (16.8 mg/ml), Kobberling syndrome was suspected; however, LMNA mutation analysis was negative. Changes in lifestyle and treatment with fenofibrate, biphasic insulin 50/50, and enalapril were initiated showing a a significant metabolic improvement: HbA1c (7.8%) and TG (243 mg/dl). FPL type 1 is a familial disease, although there are spontaneous cases. No specific mutation is responsible for this syndrome. Due to its clinical manifestations, Cushing syndrome must be discarded.
Subject(s)
Female , Humans , Middle Aged , Lipodystrophy, Familial Partial/diagnosis , Subcutaneous Fat/pathology , Arm , Acanthosis Nigricans/complications , Buttocks , Diagnosis, Differential , Lipodystrophy, Familial Partial/complications , Rare Diseases/complications , Rare Diseases/diagnosisABSTRACT
OBJECTIVE: to analyze the association between the presence of Acantose nigricans and metabolic changes in overweight adolescents, so as to ascertain the relevance of the identification of this marker in the nursing consultation. METHOD: a cross-sectional study undertaken between April 2009 and April 2010 with 118 adolescents who were service users of the Center for Child Obesity in Campina Grande in the Brazilian State of Paraíba (PB). The presence of Acantose nigricans, and the subjects' anthropometric measurements, were investigated. The following exams were made: insulin, triglycerides, HDL-Cholesterol, Glucose and the homeostatic model of assessment (HOMA-IR). RESULTS: there was association between the presence of Acantose nigricans and participants with insulin resistance (p=0.008), metabolic syndrome (p=0.031), elevated triglycerides (p=0.045) and altered HDL (p=0.002). CONCLUSIONS: the suggestion is supported that the detection/identification of Acantose nigricans may be used in the nursing consultation as a tool for identifying overweight adolescents with greater risk of metabolic changes. .
OBJETIVO: analisar a associação entre a presença de Acantose nigricans e alterações metabólicas em adolescentes com excesso de peso, a fim de verificar a relevância da identificação desse marcador na consulta de enfermagem. MÉTODO: estudo transversal, realizado entre abril/2009 e abril/2010, com 118 adolescentes, usuários do Centro de Obesidade Infantil de Campina Grande, Paraíba. Investigaram-se a presença de Acantose nigricans e as medidas antropométricas nos sujeitos. Foram realizados os exames: insulina, triglicerídeos, HDL-Colesterol, glicose e homeostático modelo de avaliação. RESULTADOS: houve associação entre a presença de Acantose nigricans e participantes com resistência insulínica (p=0,008), síndrome metabólica (p=0,031), triglicerídeo elevado (p=0,045) e HDL alterado (p=0,002). CONCLUSÕES: reforça-se a sugestão de que a detecção/identificação da Acantose nigricans pode vir a ser utilizada na consulta de enfermagem como ferramenta para a identificação de adolescentes com excesso de peso com maior risco de alteração metabólica. .
OBJETIVO: analizar la asociación entre la presencia de Acantose nigricans y alteraciones metabólicas en adolescentes con exceso de peso, a fin de verificar la relevancia de la identificación de este marcador en la consulta de enfermería. MÉTODO: estudio transversal realizado entre abril/2009 y abril/2010, con 118 adolescentes, usuarios del Centro de Obesidad Infantil de Campina Grande/PB. Fueron investigadas la presencia de Acantose nigricans y las medidas antropométricas en los sujetos. Fueron aplicados los test: insulina, triglicéridos, HDL-Colesterol, Glucosa y homeostático modelo de evaluación (HOMA-IR). RESULTADOS: fue encontrada asociación entre la presencia de Acantose nigricans y participantes con resistencia en contra de la insulina (p=0,008), síndrome metabólica (p=0,031), triglicéridos elevados (p=0,045) y HDL alterado (p=0,002). CONCLUSIONES: se subraya la sugestión de que la detección/identificación de la Acantose nigricans podrá ser utilizada en la consulta de enfermería como herramienta para la identificación de adolescentes con exceso de peso con mayor riesgo de alteración metabólica. .
Subject(s)
Adolescent , Child , Female , Humans , Male , Acanthosis Nigricans/diagnosis , Metabolic Syndrome/diagnosis , Nursing Diagnosis , Overweight/diagnosis , Acanthosis Nigricans/complications , Child Health Services , Cross-Sectional Studies , Metabolic Syndrome/complications , Overweight/complications , Risk FactorsABSTRACT
BACKGROUND: Studies have suggested an association between the presence of acanthosis nigricans (AN) and the development of diabetes. OBJECTIVE: To investigate the association between AN and insulin resistance (IR) in overweight children and adolescents receiving care at the Center for Childhood Obesity, Campina Grande, PB. METHODS: This cross-sectional study was conducted between April 2009 and April 2010 including 194 individuals of 2 to 18 years of age receiving care within the Brazilian national health network. The presence of acanthosis nigricans was verified and anthropometric measurements were taken. The following tests were performed: insulin, triglycerides, HDL-cholesterol, glucose and homeostasis model of assessment - insulin resistance (HOMA-IR). Statistical analyses were performed using the SPSS software program, version 17.0. RESULTS: There was a greater prevalence of females (66%), brown-skinned individuals (63.4%), adolescents (61.3%) and severely obese individuals (66.5%). Acanthosis nigricans was identified in 58.2% and IR in 42.7% of the participants. Acanthosis nigricans was associated with being non-white (p = 0.003), with being an adolescent (p = 0.003) and with IR (p = 0.001). Non-white individuals, adolescents and those with insulin resistance were 5.4, 2.47 and 2.66 times more likely to have acanthosis nigricans, respectively. CONCLUSION: The results of this study indicate a need to train healthcare professionals to identify acanthosis nigricans, since this condition is associated with IR. Identifying acanthosis nigricans in childhood permits the safe and timely treatment of cardiometabolic disorders through careful monitoring and appropriate treatment.
FUNDAMENTOS: Estudos sugerem haver associação entre a presença de Acantose Nigricans e o desenvolvimento do diabetes. OBJETIVO: Verificar a associação entre Acantose Nigricans e Resistência Insulínica (RI) em crianças e adolescentes com excesso de peso, atendidos no Centro de Obesidade Infantil, Campina Grande-PB. MÉTODOS: Estudo transversal realizado entre abril/2009 a abril/2010, com amostra de 194 pessoas entre 2 e 18 anos, usuários do Sistema Único de Saúde. Na avaliação, foi observada a presença de AN e verificadas as medidas antropométricas. Foram realizados os exames: insulina, triglicerídeos, HDL-colesterol, glicose e HOMA-IR. As análises estatísticas foram realizadas no SPSS, 17.0. RESULTADOS: Houve maior prevalência do sexo feminino (66%), pardos (63,4%), adolescentes (61,3%) e obesos graves (66,5%). Foi identificada AN em 58,2% e RI em 42,7%. A Acantose Nigricans esteve associada à cor não-branca (p=0,003), adolescentes (p=0,003) e RI (p=0,001). Os não-brancos apresentaram chance de 5,4 vezes maior de terem Acantose Nigricans, os adolescentes, de 2,47 e os com Resistência Insulínica, de 2,66. CONCLUSÃO: Os resultados na população em estudo indicam a necessidade de treinamento voltado à identificação da Acantose Nigricans para profissionais de saúde, pois este sinal esteve associado à Resistência Insulínica. Identificar a Acantose Nigricans desde a infância permite prevenir e tratar precocemente distúrbios cardiometabólicos, através de acompanhamento criterioso e tratamento adequado.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Infant , Young Adult , Acanthosis Nigricans/complications , Insulin Resistance/physiology , Metabolic Syndrome/etiology , Overweight/complications , Acanthosis Nigricans/blood , Acanthosis Nigricans/physiopathology , Body Mass Index , Blood Glucose/analysis , Cross-Sectional Studies , Cholesterol, HDL/blood , Homeostasis , Insulin/blood , Metabolic Syndrome/diagnosis , Metabolic Syndrome/physiopathology , Overweight/blood , Triglycerides/bloodABSTRACT
Congenital adrenal hyperplasia (CAH) is characterized by decreased adrenal hormone production due to enzymatic defects and subsequent rise of adrenocorticotrophic hormone that stimulates the adrenal cortex to become hyperplastic, and sometimes tumorous. As the pathophysiology is basically a defect in the biosynthesis of cortisol, one may not consider CAH in patients with hypercortisolism. We report a case of a 41-yr-old man with a 4 cm-sized left adrenal tumorous lesion mimicking Cushing's syndrome who was diagnosed with CAH. He had central obesity and acanthosis nigricans involving the axillae together with elevated 24-hr urine cortisol level, supporting the diagnosis of Cushing's syndrome. However, the 24-hr urine cortisol was suppressed by 95% with the low dose dexamethasone suppression test. CAH was suspected based on the history of precocious puberty, short stature and a profound suppression of cortisol production by dexamethasone. CAH was confirmed by a remarkably increased level of serum 17-hydroxyprogesterone level. Gene mutation analysis revealed a compound heterozygote mutation of CYP21A2 (I173N and R357W).
Subject(s)
Adult , Humans , Male , 17-alpha-Hydroxyprogesterone/blood , Acanthosis Nigricans/complications , Adrenal Hyperplasia, Congenital/complications , Cushing Syndrome/diagnosis , DNA Mutational Analysis , Dexamethasone/therapeutic use , Glucocorticoids/therapeutic use , Heterozygote , Hydrocortisone/urine , Mutation , Obesity/complications , Steroid 21-Hydroxylase/genetics , Tomography, X-Ray ComputedABSTRACT
OBJETIVO: Verificar a prevalência de obesidade, hipertensão arterial sistêmica (HAS), aumento de cintura e acanthosis nigricans em estudantes da cidade paulistana de Sorocaba em 2009, associando aos fatores de risco. MÉTODOS: Amostra probabilística com 680 crianças (7-11 anos) de 13 escolas municipais de Sorocaba. Um questionário avaliou a prática de atividade física, tempo com televisão, videogame e computador (TV/VG/PC), antecedentes do aluno e dos pais para hipertensão arterial, doença renal e cardíaca e nível econômico. Foram realizadas medidas de peso, altura, cintura, pressão arterial (PA) e verificado acanthosis nigricans. Determinou-se a prevalência de alteração nutricional, HAS, aumento da cintura e acanthosis nigricans. Para a associação do índice de massa corpórea (IMC) IMC > P85 e da PA > P90 com outras variáveis, empregou-se o teste do qui-quadrado ou exato de Fisher (p < 0,05) e a razão de chances prevalente bruta e ajustada. RESULTADOS: A prevalência IMC > P85 foi 22,1 por cento [IC 95 por cento: 19,0-25,3 por cento], de PA > P90 10,9 por cento [IC 95 por cento: 8,6-13,5 por cento], aumento da cintura 15,4 por cento [IC 95 por cento: 12,9-17,9 por cento] e acanthosis nigricans 3,8 por cento [IC 95 por cento: 2,6-5,6 por cento]. Foi encontrada associação do excesso de peso com antecedentes do pai (RCP: 1,76; IC 95 por cento:1,05-2,95; p = 0,02) em ambas as análises. A elevação de PA associou-se ao sexo feminino (RCP: 1,90; IC 95 por cento:1,12-3,23; p = 0,010), ao maior tempo na TV/VG/PC (RCP: 1,82; IC 95 por cento:1,00-3,36; p = 0,030), à presença de acanthosis nigricans (RCP: 8,18; IC 95 por cento:3,37-19,80; p < 0,00), à obesidade (RCP: 4,09; IC 95 por cento:2,416,94; p < 0,00) e à cintura (RCP: 4,83; IC 95 por cento:2,77-8,41; p < 0,00). Após análise multivariada, permaneceram como fatores associados o sexo feminino (RCP ajustada = 2,15; IC 95 por cento:1,17-3,93) e a obesidade (RCP ajustada = 9,51; IC 95 por cento: 4,77-18,97). CONCLUSÃO: A prevalência de excesso de peso, HAS, aumento da cintura e acanthosis nigricans foi relevante, o que justifica a realização dessas medidas.
OBJECTIVE: To verify the prevalence of obesity, systemic arterial hypertension (SAH), waist circumference and acanthosis nigricans (AN) in school children from Sorocaba, in 2009 and associate them with risk factors. METHODS: A probabilistic sample study was carried out with 680 children (7-11 years) from 13 public schools from the city of Sorocaba, SP. A questionnaire containing questions on physical activity, time spent watching television, playing with videogames and computers (TV/VG/PC), student and parental antecedents of arterial hypertension, renal or cardiac disease, and economic level was applied. On physical examination, weight, height, waist circumference (WC) and blood pressure (BP) were measured; presence of AN was observed. The prevalence of nutritional disorders, SAH, WC increase and presence of AN were calculated. To associate body mass index (BMI) > P85 and BP > P90 with the other variables, chi square or Fisher's exact test (significance p < 0.05) and crude and adjusted prevalence odds ratio (POR) were used. RESULTS: The prevalence of BMI > P85 was 22.1 percent [95 percent CI: 19.0-25.3 percent], of BP > P90 10.9 percent [95 percent CI: 8.6- 13.5 percent], increased WC 15.4 percent [95 percent CI: 12.9-17.9 percent] and AN 3.8 percent [95 percent CI: 2.6-5.6 percent]. Paternal antecedents were associated with weight excess in both analysis (POR: 1.76; 95 percent CI: 1.05-2.95; p = 0.02). High blood pressure was associated with female sex (POR: 1.90; 95 percent CI: 1.12-3.23; p = 0.01), more time spent with TV/VG/PC (POR: 1.82; 95 percent CI: 1.00-3.36; p = 0.03), AN (POR: 8.18; 95 percent CI: 3.37-19.80; p < 0.00), obesity (POR: 4.09; 95 percent CI: 2.41-6.94; p < 0.00) and WC (POR: 4.83; 95 percent CI: 2.77-8.41; p < 0.00). After the multivariate analysis, the female sex (adjusted POR = 2.15; 95 percent CI: 1.17-3.93) and obesity (adjusted POR = 9.51; 95 percent CI: 4.77-18.97) remained. CONCLUSION: The prevalence of weight excess, SAH, increased WC and AN in these school children was relevant. This fact justifies the use of these measurements.
Subject(s)
Child , Female , Humans , Male , Acanthosis Nigricans/epidemiology , Hypertension/epidemiology , Life Style , Obesity/epidemiology , Acanthosis Nigricans/complications , Body Mass Index , Brazil/epidemiology , Cross-Sectional Studies , Hypertension/complications , Obesity/complications , Prevalence , Risk Factors , Socioeconomic Factors , Waist CircumferenceABSTRACT
Some thrombophilias and severe preeclampsia may increase the risk for preterm deliveries and fetal death due to placental insufficiency. Our objective was to evaluate clinical and laboratory data as predictors of preeclampsia in a population of mothers with 3rd trimester fetal losses or preterm deliveries. In a longitudinal retrospective study, 54 consecutive women (age range: 16 to 39 years) with normotensive pregnancies were compared to 79 consecutive women with preeclampsia (age range: 16 to 43 years). Weight accrual rate (WAR) was arbitrarily defined as weight gain from age 18 years to the beginning of pregnancy divided by elapsed years. Independent predictors of preeclampsia were past history of oligomenorrhea, WAR >0.8 kg/years, pre-pregnancy or 1st trimester triglyceridemia >150 mg/dL, and elevated acanthosis nigricans in the neck. In a multivariate logistic regression model, two or more predictors conferred an odds ratio of 15 (95 percentCI [5.9-37]; P < 0.001) to develop preeclampsia (85 percent specificity, 73 percent sensitivity, c-statistic of 81 ± 4 percent; P < 0.0001). Clinical markers related to insulin resistance and sedentary lifestyles are strong independent predictors of preeclampsia in mothers with 3rd trimester fetal losses or preterm deliveries due to placental insufficiency. Women at risk for preeclampsia in this particular population might benefit from measures focused on overcoming insulin resistance.
Subject(s)
Adolescent , Adult , Female , Humans , Infant, Newborn , Pregnancy , Young Adult , Insulin Resistance/physiology , Pre-Eclampsia/etiology , Sedentary Behavior , Acanthosis Nigricans/complications , Biomarkers/blood , Epidemiologic Methods , Oligomenorrhea/complications , Pregnancy Outcome , Pre-Eclampsia/blood , Pre-Eclampsia/physiopathologyABSTRACT
Grupo de pacientes hondureñas con diagnóstico de este síndrome
Subject(s)
Humans , Adult , Female , Infertility, Female/complications , Laboratory Test/methods , Polycystic Ovary Syndrome/diagnosis , Acanthosis Nigricans/complications , Ovarian CystsABSTRACT
Apresenta-se o caso clínico de um doente de 57 anos, previamente saudável, sem sintomatologia sistêmica, que, num curto intervalo de tempo, desenvolve múltiplas lesões semelhantes a verrugas virais no tronco, membros e face, lesões típicas de acantose nigricante nas grandes pregas e uma queratodermia difusa palmar com paquidermatoglifia. Os exames complementares de diagnóstico revelaram uma neoplasia gástrica metastizada. Apesar da instituição da terapêutica, com efeito transitório na neoplasia e nas lesões cutâneas, o doente viria a falecer em 14 meses. Salientamos a associação destas três dermatoses paraneoplásicas num mesmo paciente: papilomatose cutânea florida, acantose nigricante maligna e tripe palms que parecem ter um mecanismo patogênico comum.
This paper reports the case of a 57-year-old, previously healthy male with no systemic symptoms who over a short period of time developed multiple wart-like lesions on his trunk, limbs and face, typical lesions of acanthosis nigricans in the major body folds and tripe palms. Diagnostic tests revealed a metastatic gastric adenocarcinoma. Despite the implementation of therapy, which had a transient effect on the tumor and skin lesions, the patient died in 14 months. The association of these three paraneoplastic dermatoses (florid cutaneous papillomatosis, acanthosis nigricans maligna and tripe palms) in the same patient, apparently with a common pathogenic mechanism, is noteworthy.
Subject(s)
Humans , Male , Middle Aged , Acanthosis Nigricans/complications , Papilloma/complications , Skin Neoplasms/complications , Stomach Neoplasms/complications , Acanthosis Nigricans/pathology , Fatal Outcome , Papilloma/pathology , Skin Neoplasms/pathology , Stomach Neoplasms/pathologyABSTRACT
El acromegaloidismo es una entidad en la cual se encuentran presentes algunos rasgos acromegálicos sin evidencia bioquímica de hipersecreción de hormona de crecimiento (GH), siendo la resistencia insulínica una de las posibles etiologías. Se presenta un paciente con rasgos acromegálicos, proceso neoplásico en pulmón izquierdo, acantosis nigricans (AN) generalizada y marcada resistencia a la insulina (IR). Se descartó acromegalia ante la presencia de una IGF1 normal y GH < 1 ng/ml a los 120 min en el test de tolerancia oral a la glucosa (TTOG). La acantosis nigricans puede presentarse como síndrome paraneoplásico (SPN) o puede estar asociada a enfermedad benigna en la cual está involucrada la insulinorresistencia (IR). El acrome-galoidismo está descripto en pacientes con IR grave como el caso que estamos presentando, postulándose que niveles muy elevados de insulina podrían estimular el crecimiento tisular o acral actuando a través del receptor de insulina que conservaría el mecanismo de mediar efectos anabólicos, o alternativamente a través del receptor de IGF1. No encontramos en la literatura la presencia de acromegaloidismo como SPN. En conclusión, presentamos un paciente con IR grave, pseudoacromegalia y AN, coexistiendo con un cáncer de pulmón. Tanto el acromegaloidismo como la AN parecen ser consecuencia de la marcada hiperinsulinemia. Aún así, no podemos descartar que la AN pudiera corresponder a un SPN.
Acromegaloidism is a condition characterized by features of acromegaly without biochemical evidence of excessive growth hormone (GH) production. Insulin resistance is one of the possible etiologies. We report the case of a patient with acromegalic features, a left lung neoplastic process, generalized acanthosis nigricans and severe insulin resistance. Normal IGF 1 and GH inhibition below 1 ng/ml by the oral glucose tolerance test ruled out the diagnosis of acromegaly. Acanthosis nigricans (AN) may be present as a paraneoplastic syndrome or may be associated to benign pathology in which insulin resistance is involved. Acromegaloidism has been reported in patients with severe insulin resistance as we are describing here. It is possible that very high insulin levels can stimulate excessive acral growth acting through insulin receptors that retain the ability to mediate anabolic effects, or alternatively through the IGF1 receptor. We found no data of acromegaloidism as a paraneoplastic syndrome. To summarize, we report a case of severe insulin resistance, pseudoacromegaly and AN, coexisting with a lung carcinoma. Acromegaloidism and AN appear to be due to insulin resistance, even though in this patient we cannot exclude that AN could be a paraneoplastic syndrome.
Subject(s)
Humans , Male , Middle Aged , Acromegaly/complications , Carcinoma, Squamous Cell/complications , Human Growth Hormone , Lung Neoplasms/complications , Acanthosis Nigricans/complications , Glucose Tolerance Test , Insulin ResistanceABSTRACT
Se presenta el caso de un paciente adulto mayor que acude a consulta por presentar astenia, anorexia, pérdida de peso y toma del estado general, así como dolor en el hipocondrio derecho con irradiación a epigastrio y lesiones hiperpigmentadas de la piel del tronco, miembros inferiores y superiores. Se evidenció en la biopsia de piel la presencia de acantosis nigricans, y se demostró posteriormente su carácter de síndrome paraneoplásico asociado con cáncer de estómago. Se discute la asociación entre acantosis nigricans y cáncer gástrico.
The case of an adult patient seen at the physician's office for presenting asthenia, anorexia, weight loss and malaise, as well as pain in the right hypochondrium irradating to epigastrium and hyperpigmented lesions of the trunk skin, lower and upper limbs, was presented. In the skin biopsy, it was evidenced the presence of acanthosis nigricans, and its paraneoplastic syndrome associated with stomach cancer was later proved. The connection between acanthosis nigricans and gastric cancer was discussed.
Subject(s)
Humans , Acanthosis Nigricans/complications , Stomach Neoplasms/complicationsABSTRACT
AIM: To study the prevalence of insulin resistance (IR) and its sequelae in patients with acanthosis. METHODOLOGY: Thirty six patients (28 females; eight males) with biopsy proven acanthosis nigricans and eight controls were evaluated for insulin sensitivity (IS) by estimating (a) the glucose and insulin responses to a 75 gm glucose load (Oral glucose tolerance test-OGTT), (b) the glucose disposal rate (GDR) during an intravenous insulin tolerance test (ITT). Serum androgen levels (testosterone--Te, androstenedione--ASD, Dehydro-epiandrosterone sulphate--DHEAS) were estimated in the basal state and 60 min after a bolus of insulin. Thyroid function tests (tri-iodo-thyronine--T3, thyroxine--T4, thyroid stimulating hormone--TSH) were performed in all subjects. RESULTS: The acanthotic population, overall had insignificant hyperglycemia (Area under curve of glucose--AUC-G : 17,745.5 +/- 847.5 v/s 11,051.3 +/- 274.5 mg/dl/min) and hyperinsulinemia (Area under curve of insulin -AUC-I: 20,825.2 +/- 1,287.7 v/s 6,340.1 +/- 984.2 microlU/ml/min) compared to controls during OGTT. Eight patients with acanthosis nigricans had impaired glucose tolerance and eight had overt diabetes using WHO criteria. 69.4% of the acanthotic subjects were obese and 13.9% (5/36) were hypertensive. Thyroid dysfunction was present in three (one had hypothyroidism and two had thyrotoxicosis). Reproductive disorders--menstrual irregularity (46.5%), amenorrhea (21.4%), hirsuitism (21.4%) and infertility (3.6%) was encountered in a significant number of acanthotics. Acanthotics overall had statistically higher levels of androgens; Te (females)--0.74 +/- 0.09 v/s 0.27 +/- 0.09 ng/ml (p < 0.005), ASD--1.8 +/- 0.21 v/s 0.94 +/- 0.2 ng/ml (p < 0.005) and DHEAS--1,880.8 +/- 216.3 v/s 772.8 +/- 210.4 ng/ml (p < 0.005). An elevated DHEAS correlated positively to body mass index (BMI) and android obesity. Serum Te levels correlated positively with GDR. Serum insulin levels increased progressively with obesity and acanthosis. Serum insulin was associated with progressive worsening of hyperandrogenism (as seen in non-obese controls, non-obese and obese acanthotics). CONCLUSIONS: Subjects with acanthosis nigricans should be screened for insulin resistance and its clinical and metabolic sequelae. Thyroid dysfunction should be sought in these subjects as it can be easily treated.
Subject(s)
Acanthosis Nigricans/complications , Adult , Androgens/blood , Female , Glucose Tolerance Test , Gonadotropins/blood , Humans , Insulin Resistance , Male , Obesity/complicationsABSTRACT
Esta comunicación tiene por objeto presentar un caso de Acantosis nigricans de etiología poco frecuente. La misma se caracteriza por la presencia de placas hiperpigmentadas y de tacto verrugoso aterciopelado, distribuidas simétricamente en áreas de flexión. Estas lesiones pueden ser manifestación de patologías benignas o acompañar a distintas neoplasias, constituyendo en este último caso un síndrome paraneoplásico. El caso que se presenta corresponde a un cuadro de Acantosis nigricans de etiología benigna poco frecuente.
Subject(s)
Humans , Female , Adult , Acanthosis Nigricans/complications , Acanthosis Nigricans/etiology , Acanthosis Nigricans/physiopathology , Neoplasms , Nervous System Diseases/complications , Neurotoxicity Syndromes/complications , Skin/injuries , Acanthosis Nigricans , Biperiden/therapeutic use , Catatonia/diagnosis , Catatonia/drug therapy , Diazepam/therapeutic use , Haloperidol/therapeutic useABSTRACT
Objetivo. Investigar las concentraciones séricas de insulina en condiciones basales y dinámicas en un grupo de adolescentes mexicanas caracterizadas por tener alteraciones mestruales. Métodos. Se estudiaron 77 adolescentes pospuberables: 65 de ellas, con edad promedio de 15 ñ 1.7 años, presentaban ciclos anovulatorios caracterizados por periodos mestruales con duración menor de 20 días o mayor de 45 días, y el grupo control consistió de 12 adolescentes (15 ñ 1.2 años de edad) clínicamentes sanas, con ciclos ovulatorios y sangrados endometriales normales. En todas las sujetos se obtuvieron las siguientes características clínicas: índice de masa corporal, relación cintura/cadera, presencia y severidad de acné, hirsutismo, acantosis nigricans e hiperkeratosis folicular. Se realizaron estudios de ultrasonido transabdominal de la región pélvica, así como determinaciones de suero de LH, FSH, estradiol, prolactina, testosterona, androstendiona y de la globulina transportadora de esterioides sexuales (SHBG). En todas se midió en sangre venosa la glucosa e insulina en condiciones pre y posprandiales. Resultados. Las jóvenes anovulatorias se subdividieron en tres grupos dependiendo de la presencia de acantosis nigricans y sobrepeso. Se observaron concentraciones de insulina significativamente más elevadas en los grupos con anovulación que en los controles. Las concentraciones de insulina en las anovulatorias correlacionaron con la presencia y gravedad de acantosis, la relación cintura/cadera, el índice de peso corporal y las concentraciones circulantes de SHBG. Conclusiones. Los resultados de este estudio indicaron una importante correlación entre las concentraciones en suero de la insulina y la presencia de alteraciones de la función ovárica (anovulación en adolescentes mexicanas. Estos hallazgos sugieren a la hiperinsulinemia como un marcador predictivo de anovulación crónica y de alteraciones metabólicas en la vida adulta; sin embargo, estas observaciones requieren de mayor investigación
Subject(s)
Humans , Female , Adolescent , Acanthosis Nigricans/complications , Anovulation/etiology , Blood Glucose , Body Mass Index , Case-Control Studies , Gonadal Steroid Hormones/blood , Insulin/blood , Mexico , Puberty , Polycystic Ovary Syndrome/complications , Polycystic Ovary Syndrome/diagnosis , Menstruation Disturbances/complicationsABSTRACT
Insulin sensitivity was estimated in a morbidity obese, insulin-resistant, glucose-intolerant patient before and after 4 weeks of treatment with acipimox (250 mg t.i.d), an orally-administred, long-acting antilypolitic drug. The ensuing fall in circulating levels of fasting free fatty acids was associated with a clear amelioration of insulin resistance, as assessed by a minimal model analysis of a frequently sampled intravenous glucose tolerance test as well as by an oral glucose tolerance test. Similarly, this treatment brought about a reappearence of GH response to oral stimulation with clonidine. The evidence showing acipimox-induced amelioration of insulin resistance in this patient without diet, exercise or weight loss should encourage exploring the potential utility of this drug in this type of patient
Subject(s)
Humans , Male , Adult , Glucose Tolerance Test , Fatty Acids , Nicotinic Acids/pharmacology , Obesity, Morbid/drug therapy , Growth Hormone , Clonidine/administration & dosage , Glucose Intolerance/diagnosis , Acanthosis Nigricans/complications , Hyperinsulinism/complications , Insulin/blood , Obesity, Morbid/complicationsABSTRACT
Um paciente com síndrome de Down e acanthosis nigricans extensa é apresentado. Os autores fazem uma revisäo desta doença associada com outras entidades dermatológicas