В статье систематизированы данные о заболеваниях кожи и слизистых оболочек, коморбидных заболеваниях щитовидной железы, гипоталамо-гипофизарной системы, надпочечников и других желез внутренней секреции. Многие типы клеток, расположенных в коже, имеют гормональные рецепторы с высоким сродством к определенной группе гормонов, которые регулируют их функции. Эндокринные заболевания, сопровождающиеся дефицитом или избытком гормонов, нарушают метаболизм кожи, вследствие чего кожные изменения присущи большинству эндокринопатий. Акцентируется внимание на патологических изменениях кожи, характерных для той или иной эндокринопатии. Подчеркивается важная роль дерматолога в распознавании этих нарушений и направлении больного для проведения лабораторных исследований с целью уточнения диагноза и консультации эндокринолога. Идентификация эндокринных расстройств и их медикаментозная коррекция способствуют уменьшению степени выраженности кожных проявлений и помогут существенно дополнить симптоматическое лечение кожных нарушений при эндокринопатиях.
Ключевые слова: дерматозы, ассоциированные с заболеваниями щитовидной железы, гипоталамо-гипофизарной системы, надпочечников и других желез внутренней секреции, тиреоидная дермопатия, ноготь Пламмера, витилиго, диффузная гиперпигментация, мелазма, кальциноз кожи, стрии, гиперандрогенная дерматопатия.
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The article systematizes data on diseases of the skin and mucous membranes, comorbid diseases of the thyroid gland, hypothalamic-pituitary axis, adrenal glands and other endocrine glands. Many types of cells located in the skin have hormone receptors with high affinity for a specific group of hormones that regulate their functions. Endocrine diseases with hormone deficiency or hormone excess disrupt the skin metabolism, hence most endocrinopathies are accompanied by skin lesions. Attention is focused on pathological changes in the skin which are specific for one or another endocrinopathy. The article emphasizes the important role of a dermatologist in recognizing these disorders and referring the patient for laboratory tests to clarify the diagnosis and consult an endocrinologist. Identification of endocrine disorders with their subsequent correction helps to reduce the severity of skin lesions and will help to complement the symptomatic treatment of skin lesions associated with endocrinopathies.
Key words: dermatoses associated with diseases of the thyroid gland, hypothalamic-pituitary axis, adrenal glands and other endocrine glands, thyroid dermopathy, Plummer’s nail, vitiligo, diffuse hyperpigmentation, melasma, skin calcification, striae, hyperandrogenic dermopathy.
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1. Zaitseva E.V., Kharlan A.L., Lisichenkova T.A. еt al. Kliniko-morfologicheskaia kharakteristika shchitovidnoi zhelezy cheloveka pri endemicheskom zobe. Ezhegodnik NII fundamental'nykh i prikladnykh issledovanii. 2015; 2 (1): 65–76. [in Russian]
2. Jabbour SA. Cutaneous manifestations of endocrine disorders: a guide for dermatologists. Am J Clin Dermatol 2003; 4: 315–31.
3. Freinkel RK. Cutaneous manifestations of endocrine diseases. In: Fitzpatrick TB, Eisen AZ, Wolff K et al, editors. Dermatology in general medicine. 4thed. New York: McGraw-Hill, 1993: 2113–31.
4. Rustin MH. Andrews’ diseases of the skin – clinical dermatology. Postgrad Med J 1990; 66: 984.
5. Hegedus L, Heidenheim M, Gervil M et al. High frequency of thyroid dysfunction in patients with vitiligo. Acta Derm Venereol 1994; 74: 120–3.
6. Heymann WR. Advances in the cutaneous manifestations of thyroid disease. Int J Dermatol 1997; 36 (9): 641–5.
7. Kozhnye i venericheskie bolezni. Spravochnik. Pod red. O.L.Ivanova. M.: Meditsina, 2007. [in Russian]
8. Bernhard JD, Freedberg IM, Vogel LN. The skin in hypothyroidism. In: Braverman LE, Utiger RD, editors. Werner and Ingbar’s the thyroid. 7th ed. Philadelphia: Lippincott-Raven, 1996: 792–5.
9. Lause M, Kamboj A, Fernandez Faith E. Dermatologic manifestations of endocrine disorders. Transl Pediatr 2017; 6 (4): 300–12.
10. Heymann WR. Cutaneous manifestations of thyroid disease. J Am Acad Dermatol 1992; 26: 885–902.
11. Tosti A, Baran R, Dawber RPR. The nail in systemic diseases and drug-induced changes. In: Baran R, Dawber RPR, editors. Diseases of the nails and their management. 2nd ed. Oxford: Blackwell Scientific Publications, 1994.
12. Rumbyrt JS, Katz JL, Schocket AL. Resolution of chronic urticaria in patients with thyroid autoimmunity. J Allergy Clin Immunol 1995; 96 (6): 901–5.
13. Endokrinologiia. Natsional'noe rukovodstvo. Kratkoe izdanie. Pod red. I.I.Dedova, G.A.Mel'nichenko. M.: GEOTAR-Media, 2013. [in Russian]
14. Dagher HN, Aboujaoude ZC, Jabbour SA. Chronic urticaria: an unusual initial manifestation of primary hyperparathyroidism. Endocr Pract 2002; 8 (1): 47–9.
15. Sytyi V.P., Gonchar A.A., Sytyi Iu.V. Adenomy gipofiza: istoriia, rasprostranennost', klinika, diagnostika, lechenie. Problemy zdorov'ia i ekologii. 2010; 3 (25). [in Russian]
16. Yanovski JA, Cutler GB. Glucocorticoid action and the clinical features of Cushing’s syndrome. Endocrinol Metab Clin North Am 1994; 23 (3): 487–509.
17. Davidovici BB, Orion E, Wolf R. Cutaneous manifestations of pituitary gland diseases. Clin Dermatol 2008; 26 (3): 288–95.
18. Oelkers W. Adrenal insufficiency: current concepts. N Engl J Med 1996; 335 (16): 1206–12.
19. Mountjoy KG. The human melanocyte stimulating hormone receptor has evolved to become Hunt G, Todd C, Kyne S et al. ACTH stimulates melanogenesis in cultured human melanocytes. J Endocrinol 1994; 140 (1): R1–3.
20. Carr BR. Disorders of the ovaries and female reproductive tract. In: Wilson JD, Foster DW, Kronenberg HM et al, editors. Williams textbook of endocrinology. 9thed. Philadelphia: W.B.Saunders, 1998: 795–9.
21. Taylor AE. Polycystic ovary syndrome. Endocrinol Metab Clin North Am 2008; 27 (4): 877–902.
22. Larina A.N., Shapoval'iants O.S., Mazurina N.V. Diagnostika i lechenie autoimmunnogo poliglanduliarnogo sindroma u vzroslykh. Klin. meditsina. 2012; 90 (8): 64–6. [in Russian]
23. Lause M, Kamboj A, Faith E. Dermatologic manifestations of endocrine disorders. Transl Pediatr 2017; 6 (4): 300–12.
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
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