Thick skin all over the body

Introduction The thick skin of the whole body is one of the clinical manifestations of giant human disease. The giant human disease pituitary gland secretes excessive growth hormone (GH), causing hypertrophy of tissues, bones and internal organs and diseases of endocrine and metabolic disorders. The prevalence of puberty and the closure of the ankle are giant diseases.

Cause

A pituitary: the majority, including GH cell proliferation or adenoma GH / PRL cell mixed adenoma, pro-growth growth hormone cell adenoma, eosinophilic adenoma.

In vitro: Heterologous GH/ and or GHRH-secreting tumors (pulmonary pancreatic cancer, hypothalamic hamartoma, carcinoid islet cell tumor), such tumors often fail to show the clinical manifestations of GH excessive secretion have been life-threatening.

an examination

Related inspection

Skin test growth hormone plasma auxin medium assay (SOM) whole blood glucose Hb

First, the history of symptoms and signs:

The onset is slow, and the early stage can be asymptomatic and then gradually increase in surface area, eyebrows and double humps, giant nose, large ear and lip, thick tongue, progressive mandibular protrusion, sparse teeth, enlarged nose and throat, and murmur. Appearance ugly, fingertips thick, palmar hypertrophy, thick skin, sweating, fatty, a small number of goiter, increased basal metabolic rate, mostly normal thyroid function, a few hypertrophy of the internal organs, enlarged thorax; men Sexual libido, most menstrual disorders, women with amenorrhea, half of the impaired glucose tolerance, polydipsia, polyuria, hyperprolactinemia, galactorrhea; advanced tumor compression symptoms: headache, visual field defect and high Blood pressure; secondary hypothyroidism, secondary adrenal insufficiency, atrophy, and hypofunction, osteoporosis, spinal activity limitation, and other pituitary giants. It is characterized by excessive growth in childhood, tall body, rapid growth of limbs, and excessive appetite. The late (declining) physical strength is declining.

Second, auxiliary inspection:

(1) GH determination: the basic value > 15ug / L active period up to 100ug / L or more (normal < 5ug / L);

(2) The growth medium is significantly increased (normal value is 75-200 ug/L);

(3) Increased blood glucose, impaired glucose tolerance, glucose inhibition test: glucosamine 100g before taking sugar and 1/2123 and 4h after taking sugar, GH1h decreased to less than 1ug/L, and decreased to 5ug/L after 2h. Hereinafter, after 4h, it will rise back to 5ug/L or more, and the GH is autocrine secretion is not inhibited;

(4) Determination of calcium and phosphorus: a small amount of serum calcium and phosphorus increased, urinary calcium increased, urinary phosphorus decreased, such as persistent or obvious high blood calcium may be combined with other hyperendocrine adenomas such as hyperparathyroidism;

(5) X-ray examination: the skull enlarges the thickness of the skull plate; the majority of the sella expands before and after the rupture of the sinus; the sinus enlarges the occipital trochanter and the trochanter is prominent; the distal end of the long bones of the extremities is plexus-like hyperplasia, CT scan has Helps to find patients with microadenomas.

Differential diagnosis

Should be differentiated from skin periosteal hypertrophy, vacuolar saddle and so on.

The X-ray findings of skin periosteal hypertrophy are mainly: periosteal hyperplasia of the extremities and thickening of the trunk. Symmetrical. Mainly the humerus and the ulna. The periosteum is jagged in the early stage. The layers are connected to each other as the disease progresses; the periosteum is most prominent at the distal end of the diaphysis. And gradually spread to the near end. Generally do not involve the epiphysis and metaphysis.

The vacuolar saddle is more common in women (about 90%). Especially the middle-aged and more fat multi-partum women. Headache is the most common symptom. Sometimes intense. But it lacks characteristics. Can be light. Moderate hypertension. A small number of patients have vision loss and visual field defects. Can be concentric or hemianopia. A small number of patients have benign intracranial hypertension (pseudo-brain tumors). Can be associated with optic nerve head edema and increased cerebrospinal fluid pressure. Some patients have cerebrospinal fluid rhinorrhea. The cause may be a transient increase in cerebrospinal fluid pressure. Causes the passage of the passage between the sella and the oral cavity during the embryonic period. A small number of patients are associated with hypopituitarism. Can be mild gonads and hypothyroidism. And hyperprolactinemia. The function of the posterior pituitary is generally normal. However, diabetes insipidus can occur in individual children. Children may be associated with skeletal dysplasia syndrome.

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