Abstract • 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. (Arch Intern Med 1982;142:1820-1823) References 1. Fields ML, Greenberg BH, Burkett LL: Roentgenographic measurements of skin and heel-pad thickness in the diagnosis of acromegaly. Am J Med Sci 1968;254:528-533. 2. Wortsman J, Dietrich J, Traycoff RB, et al: Preradial myxedema in thyroid disease. Arch Dermatol 1981;117:635-638.Crossref 3. Luna LG: Manual of Histologic Staining Methods of the Armed Forces Institute of Pathology . New York, McGraw-Hill Book Co, 1968, pp 1-235. 4. Kupchella CE, Drake EE, Kennedy J, et al: Tissue and urinary glycosaminoglycan patterns associated with a fast, intermediate, and a slow-growing Morris hepatoma. Cancer Res 1981;41:419-424. 5. Yamada K, Hirans K: The histochemistry of hyaluronic acid-containing mucosubstances. J Histochem Cytochem 1973;21:469-472.Crossref 6. Yamada K: The effect of digestion with Streptomyces hyaluronidase upon certain histochemical reactions of hyaluronic acid-containing tissues. J Histochem Cytochem 1973;21:794-803.Crossref 7. Derby MA, Pintar JE: The histochemical specificity of Streptomyces hyaluronidase and chondroitinase ABC. Histochem J 1978;10:529-547.Crossref 8. Tolksdorf, McCreary MH, McCullaugh DR, et al: The turbidimetric assay of hyaluronidase. J Lab Clin Med 1949;34:74-89. 9. Yamada K: The effect of digestion with chondroitinases upon certain histochemical reactions of mucosaccharide-containing tissues. J Histochem Cytochem 1974;22:266-275.Crossref 10. Kho KM, Wright AD, Doyle FH: Heel pad thickness in acromegaly. Br J Radiol 1970;43:119-125.Crossref 11. Steinbach HL, Russell W: Measurements of the heel-pad as an aid to diagnosis of acromegaly. Radiology 1964;82:418-423.Crossref 12. Sheppard RH, Meema HE: Skin thickness in endocrine disease. Ann Intern Med 1967;66:531-537.Crossref 13. Gonticas SK, Ikkos DG, Stergiou LH: Evaluation of the diagnostic value of heel-pad thickness in acromegaly. Radiology 1969;92:304-307.Crossref 14. Meema HE, Sheppard RH, Rapoport A: Roentgenographic visualization and measurement of skin thickness and its diagnostic application in acromegaly. Radiology 1964;82:411-417.Crossref 15. Gabrilove JL, Schwartz A, Churg J: Effect of hormones on the skin in endocrinologic disorders. J Clin Endocrinol Metabol 1962;22:688-692.Crossref 16. Black MM, Shuster S, Bottoms E: Skin collagen and thickness in acromegaly and hypopituitarism. Clin Endocrinol 1972;1:259-263.Crossref 17. Harris EJ Jr, Sjoerdsma A: Collagen profile in various clinical conditions. Lancet 1966;2:707-711.Crossref 18. Freinkel R, Freinkel N: Dermatologic manifestations of endocrine disorders , in Fitzpatrick TB, Eisen AZ, Wolff K, et al (eds): Dermatology in General Medicine . New York, McGraw-Hill Book Co, 1979, pp 1247-1265. 19. Harper RA, Gorve G: Human skin fibroblasts derived from papillary and reticular dermis: Differences in growth potential in vitro. Science 1979;204:526-527.Crossref 20. Holt DJA, Marks R: Epidermal architecture, growth, and metabolism in acromegaly. Br J Med 1976;1:496-497.Crossref 21. Silber JE: Mucopolysaccharides of ground substance , in Fitzpatrick TB, Eisen AZ, Wolff K, et al (eds): Dermatology in General Medicine . New York, McGraw-Hill Book Co, 1979, pp 189-195.
Archives of Internal Medicine – American Medical Association
Published: Oct 1, 1982