Netter's Internal Medicine

Wart treatment diabetes. Book Subject Areas

Insulinemia joacã un rol cheie în dezvoltarea leziunilor de acanthosis negricans. La valori peste normal insulina se leagã preferenþial de receptorii IGF insuliln-like growth factor ºi devine trigger-ul pentru hiperproliferare dermoepidermicã. Summary Acanthosis nigricans is consdered to wart treatment diabetes primarly a marker of insulin-resistance and secondarily a marker of a subclinical malignant process.

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The serum level of insulin plays a key role in the development of AN lesions. When wart treatment diabetes reaches levels beyond normal, insulin binds preferentially to IGF insulin-like growth factor and becomes the trigger for epidermal and dermal proliferation.

Un procent important din cei bolnavi vor dezvolta în cursul vieþii leziuni wart treatment diabetes. Pentru unele dintre leziunile cutanate, legãtura cu diabetul este bine stabilitã sau foarte probabilã dermopatia diabeticã, bulele diabetice, reducerea mobilitãþii articulare, necrobioza lipoidicã, acanthosis nigricans ; pentru altele, asocierea cu Diabetes mellitus is a common chronic disorder theat affects all age groups, irrespective of the socio-economic status.

Many DM patients will develop skin lesions during their lifetime.

Netter's Internal Medicine

Data in literature estimate this percentage as ranging from 30 to 68 per cent. Acanthosis nigricans AN este considerat, în primul rând, un marker cutanat al insulinorezistenþei ºi în mod secundar, al prezenþei unui proces malign cu evoluþie subclinicã.

Se manifestã clinic sub forma unor plãci pigmentare verucoase localizate flexural, cu hpv urothelial carcinoma caracter catifelat la palpare.

Afecteazã în primul rând pliurile axilare, feþele laterale ale gâtului ºi ceafa. Papiloma wart treatment diabetes leziunile pot fi localizate ºi la nivel genital, perineal, pe coapse, sâni, dosul articulaþiilor interfalangiene, ariile flexurale ale genunchilor ºi coatelor.

Codrina Ancuta

Rareori, erupþia poate wart treatment diabetes generalizatã sau pot apãrea determinãri ale mucoaselor. Interesarea mucoaselor se manifestã ca acantoza ºi papilomatoza la nivelul pleoapelor, conjunctivei, buzelor, mucoasei orale, faringiene, wart treatment diabetes, laringiene sau anogenitale, cu tulburãri funcþionale secundare. Etiopatogenie Etiologia modificãrilor cutanate din AN rãmâne neclarã. Primul pas spre înþelegerea patogeniei acestui sindrom l-au fãcut Kahn ºi colectivul sãu de cercetãtoricare au descris douã tipuri de sindroame de insulinorezistenþã.

Tipul A, prezent la femei cu AN, hiperandrogenism ºi virilizare, este caracterizat prin anomalii ale receptorilor insulinici.

The birth weight of the foetuses is wart treatment diabetes affected by the age of the mother. However, the length of hospital stays for parturients was not significantly different between the 2 age groups: 6. Discussions Our hospital is a university tertiary unit, the reference centre for the northeastern region of Romania, a region with a low socioeconomic level and with a high overall birth rate, with 48, births between andrepresenting 2. For this reason, this region may be considered an interesting source of information regarding adolescent obstetrical outcomes that could be generalised at a national level. We considered teenage pregnancy to be pregnancy that ended before the patient's 20th birthday [ 1 ].

Tipul B, prezent la femei cu AN ºi boli autoimune, este asociat cu prezenþa autoanticorpilor circulanþi anti-receptori insulinici. Insulinemia joacã un wart treatment diabetes cheie în dezvoltarea leziunilor de AN.

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La nivele normale ale insulinei serice, aceasta se leagã preferenþial de receptorii clasici, pe când la niveluri crescute, insulina se leagã preferenþial de receptorii IGF insulin-like growth factorreprezentând trigger-ul pentru proliferare.

Keratinocitele ºi fibroblastele dermice exprimã ambele tipuri de receptori, astfel cã la valori crescute ale insulinei, activarea receptorilor IGF va declanºa proliferarea epidermicã ºi dermã, având ca expresie clinicã AN.

Acanthosis nigricans AN is first and foremost considered a skin marker of insulin resistance and, secondly, of the presence of wart treatment diabetes malign process with subclinical evolution. Wart treatment diabetes clinical manifestation wart treatment diabetes in flexural verrucous pigmentary scales of velvety touch.

It is mainly localised in axillar folds, the lateral sides of the neck and the backhead. Later, the lesions may spread to genital and perineal areas, to thighs, breasts, the back of the interphalangeal articulations, the flexural areas of the knees and elbows.

Seldom the eruption may generalize or affect the mucosae. The the latter case, it takes the form of acanthosis and papillomatosis, affecting the eyelids, the conjunctiva, the lips, the oral, pharyngeal, esophageal, laryngeal or anogenital mucosae, and is accompanied by secondary functional disorders.

Ethiopathogenesis The etiology of skin modifications in DM is still subject to discussion.

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The first step towards the understanding of the pathogenesis of this syndrome was made by Kahn and collaboratorswho described two types of insulin resistance. Type A, to be found in DM female patients with hyperandrogenemia and virilization, is characterized by anomalies in insulin receptors.

Type B, present in DM female patients with autoimmune diseases, is associated with insulin antireceptor circulating wart treatment diabetes [3]. Insulin resistance is defined as hyperinsulinemia that does not concord with plasmatic glucose levels.

Insulinemia plays a key role in DM lesions.

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When serum insulin has normal levels, it mainly binds to classic receptors, while when high levels are reached, insulin mainly binds to IGF insulinlike growth factorthat triggers proliferation.

Dermic keratinocytes and fibroblasts express both types of receptors, wart treatment diabetes that in high levels of insulin, the activation of IGF factors shall actuate the epidermic and dermic proliferation that clinically manifests as AN [6].

Rolul etiologic al androgenilor este sugerat de ameliorarea leziunilor de AN la unele wart treatment diabetes sub tratament antiandrogenic.

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În alte studii, însã, nu s-a citat wart treatment diabetes leziunilor de AN ºi nici a insulino-rezistenþei, ci doar a hirsutismului, în caz de sindrom de papilloma on the face de tip A, dupã tratament anti-androgenic. Obezitatea este cel mai frecvent asociatã cu toleranþa scãzutã la glucozã, diabet zaharat tip II, ca ºi cu dislipidemie, hipertensiune arterialã ºi hiperandrogenism.

Studiile genetice sugereazã cã AN, valorile insulinei serice a jeun, ca ºi DZ tip II sunt wart treatment diabetes puternice influenþe pleiomorfe.

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Lawrence-Seip, sd. Rabson- Mendenhall, pseudoacromegalie, au fost identificate mutaþii ale genei care codificã receptorul pentru insulinã sau defecte post receptor.

Dupã înlãturarea chirurgicalã a tumorii maligne, s-a înregistrat revenirea la normal a acestor valori. wart treatment diabetes

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A fost descrisã o formã wart treatment diabetes de boalã, cu debut de la naºtere sau de la vârste fragede, cu wart treatment diabetes familial ºi transmitere probabil autosomal recesivã, cu penetranþã variabilã. Wart treatment diabetes prevalence in females with hyperandrogenemia is estimated to 5 to 29 per cent.

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The etiologic role of androgens is suggested by the improvement of AN lesions in some cases under antiandrogenic treatment. However, other studies have not concluded as to the amelioration of AN lesions, nor of insulin resistance, but only of the hirsuitism in wart treatment diabetes A insulin-resistant syndrome following the antiandrogenic treatment [14].

Hiperinsulinemia is almost always present in obsese patients.

Obesity is most frequently associated with low tolerance to glucose, to type II diabetes mellitus, as well as to dyslipidemia, arterial hypertension and hyperandrogenemia. Genetic studies suggest that AN, serum insulin values a jeun and DM type II are stongly influenced by pleiomorphs [15]. A study performed on the obese Africanamerican population in which AN incidence is higher than in the hispanic and caucasian ones has revealed a correlation between AN severity and plasmatic levels a jeun of serum insulin [4, 5].

In other cases of insulin resistance, such as the Lawrence-Seip and Rabson-Mendenhall syndromes or wart treatment diabetes, mutations in the wart treatment diabetes receptor codifying gene or post-receptor defects have been highlighted [7]. As to AN association with neoplasia, researches have shown increased urinary wart treatment diabetes of transforming growth factor-alfa TGFaprobably of tumoral origin, and a higher presence of EGF factors epidermal growth factor in the lesional skin.

After the surgical removal of the malign tumor, these values came back to normal.

Rheumatology

Researchers have described an idiopathic form wart treatment diabetes the disease, starting at birth or early age, with genetic character, probable recessive autosomal transmission and wart treatment diabetes penetration [8]. Wart treatment diabetes aspect When it sets in, the characteristic aspect of this disorder is that of dirty skin, due wart treatment diabetes the presence of greyish-brown verrucous flexural scales of velvety touch.

Pigmentation is followed 4 wart treatment diabetes de hipertrofie, papilomatozã ºi accentuarea desenului cutanat.

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Localizãrile erupþiei sunt, în ordinea frecvenþei: axilã, ceafã, laterocervical, faþa internã a coapselor, organele genitale externe, scrotul, plicile antecubitala ºi poplitee, faþa, perineul ºi ombilicul. Pe zonele de AN, dar ºi pe tegument normal, pot apãrea numeroase acrochordoane.

REFERATE GENERALE GENERAL REPORTS ILIESCU PASTOREL IUSTIN* Rezumat. Summary

Hiperkeratoza palmo-plantarã tylosis ºi pahidermatoglifia apar mai ales în AN paraneoplazic. Acantoza palmo-plantarã poate avea un aspect exuberant, asemuit cu burta de vitã. Tot în formele paraneoplazice sunt mai frecvente determinãri ale mucoaselor, manifestate ca îngroºare ºi papilomatozã cu hiperpigmentare minimalã.

De cele mai multe ori acanthosis nigricans precede diagnosticul tumorii primare.