How do you diagnose endocrine disease from skin findings?
- Most skin findings are nonspecific but related to the specific effect of the hormone on the skin. An example is dry, thickened skin in hypothyroidism or skin infections in diabetes. Dry skin and skin infections may occur in many other diseases or, in most cases, such as dry skin in a dry climate or folliculitis, happen in otherwise normal people.
- Nonspecific skin findings are grouped with nonspecific findings from other organ systems to suggest the appropriate endocrine diagnosis. Dry, thickened skin with weight gain, fatigue, depression, and lethargy would be highly suggestive of hypothyroidism. Multiple skin or mucous membrane infections with yeast or bacteria coupled with increased urination should prompt tests for diabetes.
- More specific skin findings often occur in a minority of patients with endocrinologic disease but are highly suggestive of the diagnosis when present. Patients with acanthosis nigricans or necrobiosis lipoidica should be screened for diabetes. Pretibial myxedema is a feature of Graves’ hyperthyroidism. Xanthelasma is associated with cardiovascular risk and more subtle lipid abnormalities. Eruptive xanthomas occur with marked hypertriglyceridemia and tuberous xanthomas with very high serum cholesterol.
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