Petrified Ears: A Clue for Adrenal Insufficiency

Abstract

Petrified ears is an uncommon clinical entity. It describes auricular cartilage hardening, due usually to ectopic calcification or, less commonly, ossification. The most common causes are frostbite and mechanical trauma. However, endocrinopathies have also been reported to cause ectopic calcium deposition through an unknown mechanism. Addison's disease is the systemic disease most frequently associated, but the exact pathogenesis remains unclear. Patients are usually asymptomatic, and the diagnosis is made incidentally when rigid helices are noted on palpation and can be confirmed by radiological imaging. A biopsy can also help to differentiate between calcification and ossification. The presence of this condition may be a useful clinical sign, which in some cases precedes the development of endocrinopathies by many years. We report on a case, and we review the current literature.

Keywords: auricular calcification; ear reconstruction; ectopic calcification; metastatic calcification; petrified ears.

Figure 1

(A) Petrified ear with squamous cell carcinoma (arrow); (B) Digital probing detects inflexible stiffness in both ears.

Figure 2

(A) X-ray of the skull showing opacification of both helices; (B) Computerized tomography of skull reveals calcification of right and left pinna.

Figure 3

Histologic findings. Invasive, well-differentiated squamous cell carcinoma: keratinizing tumor infiltrating into the dermis (Hematoxylin and eosin, 2.5×).

Figure 4

(A) Pre-auricular flap design; (B) The flap is undermined and transposed; (C) At the end of the first stage the distal end of the flap is sutured to the recipient site; (D) Final result at two months.