Dermatologic manifestations of endocrine disorders

Abstract

The skin serves as a window for clinicians to understand, diagnose, and monitor endocrine disease. Dermatologic manifestations of endocrinopathies contribute significantly to an individual's health and quality of life. In this review, we outline various disorders of the hypothalamic-pituitary axis, thyroid gland, pancreas, adrenal gland, and androgen axis as well as hereditary endocrine syndromes. In acromegaly, glycosaminoglycan deposition contributes to a thickening of skin and soft tissue, which manifests as coarsening and enlargement of facial and acral structures. Stimulation of the thyrotropin receptor in hyperthyroidism results in mesenchymal tissue proliferation and consequent pretibial myxedema; other associated cutaneous features include onycholysis, and hyperhidrosis. Individuals with hypothyroidism exhibit cold, dry skin and brittle hair as well as a jaundice-like appearance due to carotene excess. The cutaneous features of diabetes mellitus (DM), mediated to a large extent by hyperglycemia and hyperinsulinemia, include necrobiosis lipoidica diabeticorum (NLD), diabetic dermopathy, and acanthosis nigricans. Pediatric patients with Cushing's syndrome almost invariably present with truncal obesity and growth retardation; disruption of collagen formation and the catabolic effects of hypercortisolism result in skin atrophy and purple abdominal striae. In patients with Addison's disease, generalized hyperpigmentation, secondary to elevated levels of melanocyte-stimulating hormone (MSH), is most prominent in sun-exposed areas. Due to hyperandrogenism, individuals with polycystic ovarian syndrome (PCOS) often exhibit hirsutism, acne vulgaris, and androgenetic alopecia. In multiple endocrine neoplasia (MEN) syndromes, specific gene mutations may lead to angiofibromas, lichen amyloidosis, and ganglioneuromas. Disruptions of immune regulation result in autoimmune polyglandular syndromes (APS) and associated clinical features including chronic mucocutaneous candidiasis, vitiligo, and alopecia areata. This paper highlights the underlying pathophysiology, dermatologic manifestations, and treatment of the aforementioned endocrine disorders.

Keywords: Dermatology; cutaneous; endocrine; manifestations.

Figure 1

NLD. Yellow-brown plaques with central atrophy on the anterior leg. NLD, necrobiosis lipoidica diabeticorum.

Figure 2

Acanthosis nigricans. Velvety, hyperpigmented plaque on the posterior and lateral neck.

Figure 3

Dorsocervical fat pad: fat deposition on the posterior neck and upper back in a patient with iatrogenic Cushing syndrome.

Figure 4

Steroid-induced acne. Monomorphic erythematous papulo-pustules on posterior trunk caused by exogenous use of corticosteroids.

Figure 5

Angular cheilitis secondary to Candida albicans in a patient with APS. APS, autoimmune polyglandular syndromes.

Figure 6

Chronic candidal paronychia: erythema and swelling of proximal nail folds along with yellowish thickening of nails.