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World Journal of Diabetes May 2021Insulin has complex effects on cell growth, metabolism and differentiation, and these effects are mediated by a cell-surface bound receptor and eventually a cascade of... (Review)
Review
Insulin has complex effects on cell growth, metabolism and differentiation, and these effects are mediated by a cell-surface bound receptor and eventually a cascade of intracellular signaling events. Among the several metabolic and growth-promoting effects of insulin, insulin resistance is defined as an attenuated effect of insulin on glucose metabolism, primarily the limited export of blood glucose into skeletal muscle and adipose tissue. On the other hand, not all the signaling pathways and insulin-responsive tissues are equally affected, and some effects other than the metabolic actions of insulin are overexpressed. Ovaries and the adrenal glands are two examples of tissues remaining sensitive to insulin actions where insulin may contribute to increased androgen secretion. Polycystic ovary syndrome (PCOS) is the most common form of androgen excess disorder (AED), and its pathogenesis is closely associated with insulin resistance. Patients with idiopathic hirsutism also exhibit insulin resistance, albeit lower than patients with PCOS. Although it is not as evident as in PCOS, patients with congenital adrenal hyperplasia may have insulin resistance, which may be further exacerbated with glucocorticoid overtreatment and obesity. Among patients with severe insulin resistance syndromes, irrespective of the type of disease, hyperinsulinemia promotes ovarian androgen synthesis independently of gonadotropins. It is highly debated in whom and how insulin resistance should be diagnosed and treated among patients with AEDs, including PCOS. It is not suitable to administer an insulin sensitizer relying on only some mathematical models used for estimating insulin resistance. Instead, the treatment decision should be based on the constellation of the signs, symptoms and presence of obesity; acanthosis nigricans; and some laboratory abnormalities such as impaired glucose tolerance and impaired fasting glucose.
PubMed: 33995849
DOI: 10.4239/wjd.v12.i5.616 -
PloS One 2020Acanthosis nigricans (AN) is a strong correlate of obesity and is considered a marker of insulin resistance (IR). AN is associated with various other cardiometabolic...
AIM
Acanthosis nigricans (AN) is a strong correlate of obesity and is considered a marker of insulin resistance (IR). AN is associated with various other cardiometabolic risk factors (CMRFs). However, the direct causal relationship of IR with AN in obesity has been debated. Therefore, we aimed to examine the complex causal relationships among the troika of AN, obesity, and IR in Mexican Americans (MAs).
METHODS
We used data from 670 non-diabetic MA children, aged 6-17 years (49% girls). AN (prevalence 33%) severity scores (range 0-5) were used as a quasi-quantitative trait (AN-q) for analysis. We used the program SOLAR for determining phenotypic, genetic, and environmental correlations between AN-q and CMRFs (e.g., BMI, HOMA-IR, lipids, blood pressure, hs-C-reactive protein (CRP), and Harvard physical fitness score (PFS)). The genetic and environmental correlations were subsequently used in mediation analysis (AMOS program). Model comparisons were made using goodness-of-fit indexes.
RESULTS
Heritability of AN-q was 0.75 (p<0.0001). It was positively/significantly (p<0.05) correlated with traits such as BMI, HOMA-IR, and CRP, and negatively with HDL-C and PFS. Of the models tested, indirect mediation analysis of BMI→HOMA-IR→AN-q yielded lower goodness-of-fit than a partial mediation model where BMI explained the relationship with both HOMA-IR and AN-q simultaneously. Using complex models, BMI was associated with AN-q and IR mediating most of the CMRFs; but no relationship between IR and AN-q.
CONCLUSION
Our study suggests that obesity explains the association of IR with AN, but no causal relationship between IR and AN in Mexican American children.
Topics: Acanthosis Nigricans; Adolescent; Biomarkers; Cardiovascular Diseases; Child; Female; Humans; Incidence; Insulin Resistance; Male; Metabolic Syndrome; Mexican Americans; Obesity; United States
PubMed: 33057385
DOI: 10.1371/journal.pone.0240467 -
Cureus Nov 2020A 47-year-old Asian Indian woman presented with uncontrolled hyperglycaemia and osmotic symptoms despite multiple oral antidiabetic medications and insulin. She had a...
A 47-year-old Asian Indian woman presented with uncontrolled hyperglycaemia and osmotic symptoms despite multiple oral antidiabetic medications and insulin. She had a history of recurrent oral ulcers, profound weight loss, and intermittent fever for one and a half years before the presentation. She had severe acanthosis nigricans, although her body mass index (BMI) was 14.6 kg/m. Her blood glucose remained uncontrolled despite very large dosages of intravenous insulin (more than 12,000 units daily). Evaluation for possible underlying collagen vascular diseases and malignancies were negative. Her serum insulin levels were high. She tested negative for anti-insulin antibodies but positive for anti-insulin-receptor antibodies. She improved with a pulse dose of intravenous methylprednisolone but relapsed within one month. A second pulse dose was given following which a complete remission of diabetes and regression of acanthosis was observed. Type B insulin resistance, a rare cause of severe insulin resistance, may respond favourably to immunosuppressive therapy with high-dose methylprednisolone.
PubMed: 33304668
DOI: 10.7759/cureus.11330 -
World Journal of Clinical Cases Nov 2020Acanthosis nigricans (AN), Leser-Trélat sign, and tripe palm are all skin diseases. To date, reports of these appearing as a paraneoplastic syndrome in a gastric cancer...
BACKGROUND
Acanthosis nigricans (AN), Leser-Trélat sign, and tripe palm are all skin diseases. To date, reports of these appearing as a paraneoplastic syndrome in a gastric cancer patient are quite rare.
CASE SUMMARY
We report the case of a 61-year-old man with darkened skin color in the face and torso with no obvious inducement after 1 year of treatment for Riehl's melanosis. He had 40 brown maculopapular eruptions on his face and the top of his head with obvious itching. Papillary wart-like hyperkeratosis with dark brown pigmentation was also observed on both sides of the areola. He had papilloma-like lesions on the face, around the orbit, and on the neck. His bilateral palms had small, smooth, papillary projections with millet-like appearance. Histopathological examination of the skin showed that the patient was suffering from AN, tripe palms, and Leser-Trélat sign. Gastroscopy showed the patient's cardia was affected, and pathological biopsy revealed that he had moderate-to-poorly differentiated adenocarcinoma. Computed tomography test results showed that his cardia wall had thickened. Based on these histological and skin characteristics, the patient was diagnosed with gastric cancer with AN, tripe palms, and Leser-Trélat sign.
CONCLUSION
Researchers should follow up on patients with malignant AN, Leser-Trélat sign, and tripe palms.
PubMed: 33344554
DOI: 10.12998/wjcc.v8.i22.5632 -
Iranian Journal of Public Health Jul 2021
PubMed: 34568197
DOI: 10.18502/ijph.v50i7.6651 -
Annals of African Medicine 2024Over the past three decades, there has been a significant rise in the prevalence of noncommunicable diseases (NCDs) globally, accompanied by a relative decline in...
Utility of "Acanthosis Nigricans" and "Skin Tags" as a screening tool for risk of developing noncommunicable diseases: A cross-sectional study at a health facility in Lucknow (India).
CONTEXT
Over the past three decades, there has been a significant rise in the prevalence of noncommunicable diseases (NCDs) globally, accompanied by a relative decline in communicable diseases.
AIMS
With this background, the research was planned to determine the prevalence of acanthosis nigricans (AN) or skin tags (STs) in the study population and to examine the relationship between the presence of AN and ST with commonly used indicators such as waist-to-height ratio (W/Ht.), Indian Diabetes Risk Score (IDRS), and body mass index for predicting the risk of NCDs.
SETTINGS AND DESIGN
This cross-sectional study was done at a health facility in Lucknow (India).
METHODOLOGY
Consecutive sampling was employed to select 152 apparently healthy adults as the participants. Data collection involved administering a questionnaire and conducting anthropometry using standardized methods. Visual inspection was conducted to identify AN or ST on the common sites.
STATISTICAL ANALYSIS USED
Data entry was done in Microsoft Office Excel, followed by data analysis using SPSS. To test the association between variables "significance of difference of mean," Chi-square test, logistic regression analysis, and estimation of Kohen's kappa were used. A "P" value was considered statistically significant at <0.05 level. The sensitivity and specificity of AN and ST were also estimated in predicting the risk of NCDs.
RESULTS
The prevalence of AN was 19.08% (95% confidence interval [CI] = 12.76%-25.40%), while the prevalence of STs was 28.29% (95% CI = 21.05%-35.53%). AN showed a sensitivity of 22.4% and specificity of 96.3% with W/Ht. ratio as the standard, and a sensitivity of 26.44% and specificity of 90.77% with IDRS as the standard. ST exhibited a sensitivity of 32.0% and specificity of 88.89% with W/Ht. ratio as the standard, and a sensitivity of 37.93% and specificity of 84.62% with IDRS as the standard.
CONCLUSION
AN and ST can be used as simple and time-saving tools in screening protocols for (NCDs). Further research is desirable to validate the findings.
Topics: Adult; Humans; Acanthosis Nigricans; Cross-Sectional Studies; Noncommunicable Diseases; Skin Neoplasms; Diabetes Mellitus; Health Facilities
PubMed: 38358168
DOI: 10.4103/aam.aam_90_23 -
International Journal of Women's... Jun 2021Hirsutism is common across ethnicities and a significant cause of negative self-esteem from presumptive loss of femininity. It remains understudied in Indian patients. (Review)
Review
BACKGROUND
Hirsutism is common across ethnicities and a significant cause of negative self-esteem from presumptive loss of femininity. It remains understudied in Indian patients.
OBJECTIVE
We studied the clinical and investigative attributes of patients with hirsutism.
METHODS
The medical records of 233 patients with hirsutism diagnosed between 2014 and 2019 were analyzed retrospectively.
RESULTS
The complete records of 122 patients age 14 to 45 years were available. Approximately 32% were adolescents, and 50% patients were age 21 to 30 years. The mean ± standard deviation modified Ferriman-Gallway (mF-G) score was 17.95 ± 10.58, and hirsutism was graded zero/mild in 57.4% patients. Polycystic ovaries were present in 29.5% of patients. Serum-free testosterone levels were elevated in 16.4% of patients. Associated signs of clinical hyperandrogenism, such as acne, obesity, acanthosis nigricans, and menstrual irregularities, were present in 12 patients (9.8%). Familial hirsutism occurred in 13% of patients and was idiopathic in 10.7% of patients. Significantly more patients (47.7% vs. 27.9%) with severe hirsutism did not complete investigations compared with those with mild hirsutism (45.9% vs. 21.6%), which may be due to the high cost of investigative work-up (as often stated by many patients) compared with periodic depilation.
LIMITATIONS
The mF-G score is a visual and subjective scale, and its validity remains limited by interobserver variations. The score's cut-off values may vary among races/ethnicities. A small number of patients and the retrospective study design are other limitations.
CONCLUSION
Hirsutism of polycystic ovary syndrome or idiopathic origin is not uncommon in Indian women. Hirsutism of adrenal or thyroid origin remains uncommon. Self-referral and high cosmetic concerns for facial hair were common in adolescents and young unmarried patients, and the majority had an mF-G score of < 8 to 16. Cut-off values for the mF-G score specific to our population assigning higher than current mF-G value to facial hair are highly desirable.
PubMed: 34222577
DOI: 10.1016/j.ijwd.2020.11.007 -
Open Access Macedonian Journal of... Sep 2019Acanthosis nigricans (AN) is acquired hyperpigmentation of the intertriginous body regions. Histologically, AN is characterised by a thickened stratum corneum and a...
BACKGROUND
Acanthosis nigricans (AN) is acquired hyperpigmentation of the intertriginous body regions. Histologically, AN is characterised by a thickened stratum corneum and a variable amount of acanthosis. Although benign and rarely symptomatic, AN may be a red flag for underlying pathologies.
CASE PRESENTATION
We analysed our patients with AN and could differentiate three different patterns, that are illustrated by one case report each. The is the benign AN associated with metabolic syndrome including obesity. The second type is the paraneoplastic AN malignancy which is associated with a wider range of malignancies. This type may occur before, after or with the clinical appearance of the malignancy. The third type is relapsing AN after complete remission. We present a patient who had a malignant AN and was treated successfully for his cancer. Years later, however, AN relapsed. In that case in association with the appearance of skin tags. Cancer restaging excluded a tumour relapse. His BMI was 31.2 kg/m, and the diagnosis of benign AN was confirmed.
CONCLUSIONS
The diagnosis of AN remains incomplete without screening for metabolic syndrome and/ or cancer. The combination of AN and skin tags is more often associated with metabolic syndrome. AN may be considered as a red flag for malignancies and the metabolic syndrome.
PubMed: 31850127
DOI: 10.3889/oamjms.2019.258 -
Dermatology Practical & Conceptual Feb 2022
PubMed: 35223154
DOI: 10.5826/dpc.1201a09 -
Anais Brasileiros de Dermatologia 2023Globally, few studies have been undertaken to assess the association of acanthosis nigricans (AN) with metabolic syndrome (MS). Most of the available studies have either...
BACKGROUND
Globally, few studies have been undertaken to assess the association of acanthosis nigricans (AN) with metabolic syndrome (MS). Most of the available studies have either focused on a particular age group, gender, ethnicity or on a single component of MS.
OBJECTIVES
To determine the association between AN and MS as a whole and with all individual components of MS in adult patients of either gender.
MATERIAL AND METHODS
This was a cross-sectional study with a comparative group. Eighty-one subjects were recruited in each group. Fasting plasma glucose (FPG) and lipid profile were done. MS was defined by using the international diabetic federation (IDF) criteria. Association of body mass index (BMI), waist circumference, blood pressure, FPG, high-density lipoprotein (HDL) and triglycerides (TG) with AN was assessed by Pearson's chi-square test followed by univariate and multivariate analysis.
RESULTS
The prevalence of MS was found to be significantly higher in the group with AN. On univariate analysis, a significant association of AN was found with BMI, waist circumference, high systolic and diastolic blood pressure, HDL, and TG. Multivariate analysis revealed a significant association between waist circumference, high systolic and diastolic blood pressure, and high TG levels with AN. The risk of MS was found to be eight times higher in cases of AN.
STUDY LIMITATIONS
The small sample size and single-center data are the limitations of the present study.
CONCLUSION
AN is strongly associated with MS as a whole and with its individual components including increased waist circumference, hypertension, and dyslipidemia.
Topics: Adult; Humans; Metabolic Syndrome; Cross-Sectional Studies; Acanthosis Nigricans; Body Mass Index; Triglycerides; Lipoproteins, HDL; Risk Factors
PubMed: 36964104
DOI: 10.1016/j.abd.2022.07.006