Pathologies of the skin and its appendages in endocrine diseases Patologie skóry i jej przydatków w schorzeniach endokrynologicznych

AbstrAct Patients suffering from endocrine disorders often present a wide profile of skin lesions. In hyperthyroidism we observe hair loss, lower leg myxedema and onycholysis or, in the case of hormone deficiency, generalized swelling of the skin, which becomes cold and pale. Primary hyperparathyroidism is revealed by pruritus, presence of chronic urticaria or deposition of amorphous calcium salts. In hypoparathyroidism, the skin is dry while the nails become very brittle. Skin lesions in diabetes include necrobiosis lipoidica, granuloma annulare, scleroderma-like diabetic edema and acanthosis nigricans. Overactive pituitary gland is often manifested as acromegaly with hypertrophy of soft tissue thickening and hypertrichosis. The skin in the early stages of hypopituitarism feels swollen, is pale yellow and oily, and finally becomes alabaster and dry. The characteristic features of Cushing syndrome are central obesity, lunar face, buffalo hump, and striae. In Addison's disease we observe hyperpigmentation. Hyperandrogenism in women leads to acne, hirsutism and virilization. streszczenie Zaburzeniom endokrynologicznym często towarzyszy szeroki zakres zmian skórnych. W nadczynności tarczycy obserwujemy utratę wło-sów, obrzęk przedgoleniowy i odwarstwienie płytki paznokciowej lub -jak w przypadku niedoboru hormonów -uogólniony obrzęk śluzo-waty skóry, która staje się zimna i blada. Pierwotna nadczynność przytarczyc objawia się świądem, obecnością przewlekłej pokrzywki lub odkładaniem bezpostaciowych soli wapnia. W niedoczynności przytarczyc skóra jest sucha, natomiast paznokcie są bardzo kruche. Zmiany skórne w cukrzycy obejmują między innymi obumieranie tłuszczowate, ziarniniaka obrączkowatego, obrzęk cukrzycowy twardzinopodobny oraz rogowacenie ciemne. Nadczynność przysadki często objawia się jako akromegalia z przerostem tkanek miękkich, pogrubieniem rysów twarzy oraz nadmiernym owłosieniem. Skóra w początkowym okresie niedoczynności przysadki sprawia wrażenie obrzękniętej, jest bladożółta i tłusta, a w miarę progresji zaburzeń staje się alabastrowa i sucha. Charakterystyczne cechy zespołu Cushinga to centralna otyłość, księżycowata twarz, bawoli kark oraz rozstępy. W chorobie Addisona obserwujemy przebarwienia. Hiperandrogenizm u kobiet powoduje trądzik, hirsutyzm oraz wirylizację

Pathologies of the skin and its appendages in endocrine diseases

Patients suffering from endocrine disorders often present a wide profile of skin lesions. In hyperthyroidism we observe hair loss, lower leg myxedema and onycholysis or, in the case of hormone deficiency, generalized swelling of the skin, which becomes cold and pale. Primary hyperparathyroidism is revealed by pruritus, presence of chronic urticaria or deposition of amorphous calcium salts. In hypoparathyroidism, the skin is dry while the nails become very brittle. Skin lesions in diabetes include necrobiosis lipoidica, granuloma annulare, scleroderma-like diabetic edema and acanthosis nigricans. Overactive pituitary gland is often manifested as acromegaly with hypertrophy of soft tissue thickening and hypertrichosis. The skin in the early stages of hypopituitarism feels swollen, is pale yellow and oily, and finally becomes alabaster and dry. The characteristic features of Cushing syndrome are central obesity, lunar face, buffalo hump, and striae. In Addison’s disease we observe hyperpigmentation. Hyperandrogenism in women leads to acne, hirsutism and virilization

Pregnancy: a therapeutic dilemma

Treatment during pregnancy is problematic. The Food and Drug Administration established drug categories to help in the treatment process. First-generation antihistamines are considered safe but they have sedative properties. Second-generation antihistamines cause less adverse reactions but besides cetirizine and loratadine they belong to category C. All retinoids should be avoided during pregnancy due to the risk of fetal malformations. Antimalarial drugs should be considered based on the clinical data. Sulfones can be considered as safe for use during pregnancy only with proper monitoring. Prednisone is administered in pregnancy. Other glucocorticosteroids have a different safety profile. Cyclosporine A treatment should be reserved as rescue therapy in severe stages of the disease. Treatment during pregnancy should be precise when it comes to pregnant woman and safe for the fetus