Download Association Between Skin Tags and Colonic Polyps in Patients with

Turkish Journal of Endocrinology and Metabolism, (2005) 2 : 45-47
ORIGINAL ARTICLE
Association Between Skin Tags and Colonic
Polyps in Patients with Acromegaly
Neslihan Kurtulmuş*
Sema Yarman**
Kadir Demir***
Fırat
* Educational and Research Hospital of Vakıf Gureba, Endocrinology Unit, İstanbul
** İstanbul University, Istanbul Medical Faculty, Division of Endocrinology, Metabolism and Nutrition, İstanbul
*** İstanbul University, Istanbul Medical Faculty, Division of Gastroenterohepatology, İstanbul
The high prevalence of colonic polyps in acromegalic patients is well known. Colonic
adenomatous polyps may be precursor lesions for colorectal carcinoma. Skin tags
are generally benign skin growths, but it has been reported that there is a correlation
between skin tags and colonic polyposis in acromeglic patients. We evaluated
association between colonic polyps and skin tags in twenty-five acromegalic
patients. The aged over 70, previous colonic disease or polyps, rectal bleeding,
positive family history for colon disease and smoking were exclusion criterians in the
study. Colonoscopy was performed in all patients and colonic polyps were found in
ten of them. Skin tags were detected in eight of ten patients with colonic polyps. The
specificity and sensitivity of the presence of polyps with skin tags was high However
Fisher’s exact test was not statistically significant. As a conclusion, colonoscopy
should be performed in all acromegalic patients especially in those with skin tags.
Key words: Acromegaly, colon polyps, skin tag
Introduction
Acromegaly is a rare disease characterized by
enlargements of the acral parts and visceromegaly.
Overproduction of growth hormone from a tumour
of anterior pituitary gland causes acromegaly (1).
Several studies reported an increased prevalence of
colonic polyps in acromegalic patients and these
patients are known to have an increased prevalence
of colorectal carcinoma (2-5). However, risk
factors of colonic polyps and colorectal carcinoma
in acromegalic patients are still uncertain. Several
risk factors are male gender, long duration of
disease, high level of insulin-like growth factor,
family history of colon cancer, age greater than 50
years, and skin tags (2,6). Skin tags, also known as
achrochordon are very common, and are generally
benign skin growths. Usually, they are very small,
but sometimes are half an inch long and they are
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located on the neck, armpits, trunk, body folds, or
other areas (7). Their origin is unknown. Diagnosis
is based primarily on the appearance of the skin
growth (7). An association between high number
of skin tags (more than three) and colonic polyps
in acromegalic patients has been reported (8,9). In
this study, we evaluated the association between
colonic polyps and skin tags in patients with
acromegaly on admission.
Subjects and Methods
Twenty-five acromegalic patients 14 men and 11
women aged 25 to 70 years (mean, 45.6 ± 11
years), were evaluated for the relation between
colonic polyps and skin tags. None of patients had
any risk factors for colonic polyps and colorectal
cancer such as familial polyposis syndromes, a
family history of hereditery colon cancer, a history
of inflamatory bowel disease and smoking. We
didn’t include patients which has any risc factors
for colon polips. Twenty-three patients had active
disease. Two patients were in remission. The
diagnosis of acromegaly was established by clinical
findings and then confirmed by the findings of
elevated plasma concentrations of growth hormone
(GH) that were not suppressed below 2 ng/ml (by
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ORIGINAL ARTICLE
RIA) after administration of an oral glucose load
(100mg) and high serum insulin-like growth factor
I (IGF-I) levels and radiological demonstration of a
pituitary adenoma. After bowel preparation, total
colonoscopy was performed with a fiberoptic
colonoscope by an experienced endoscopist in the
department of gastroenterology. Colonic polyps
were removed endoscopically and examined
histologically. Before colonoscopy, each patient
was examined spesifically to determine the
presence of skin tags (Figure 1). The location and
number of skin tags were noted.
located on the neck, near the axilla or upper trunk.
Because of diagnosis is based primarily on the
appearance of the skin growth and they were
thought to be simple skin tags, we did not examine
these lesions histologically. Skin tags were also
present along with colon polyps in 8 of 10 patients.
The positivity ratio, false positivity ratio, the sensivity
(presence of both skin tag and colon polips), and
the specifity (absence of both skin tags and colon
polips) were 80%, 47%, 53%, 80% respectively.
This result seems to be meaningful. Odds ratio was
4.57 and it showed that patients with skin tags had
high risk for colon polyps. However Fischer’s
exact test was not stutistically significant.
Figure 1.
Statistical analysis
Figure 2.
The degree of association between skin tags and
the presence of colonic polyps in acromegalic
patients was estimated by the odds ratio, the
strength of the association was calculated using the
Fisher’s exact test. The specificity (the probability
of the presence of skin tags conditional on the
presence of colonic polyps) and sensitivity (the
probability of the absence of polyps given the
presence of skin tags) were evaluated.
Results
Colonoscopic examination was complete to the
cecum in twenty-two patients (%88). All of the
patients had dolichomegacolon. Ten of the
twentyfive acromegalic patients (%40) had colonic
polyps (Figure 2). These polyps were underwent
polypectomy. Histologically, seven patients had
adenomatous polyps and three patients had
hyperplastic polyps. None of the patients had
colorectal carcinoma. In skin examination, fifteen
of the patients (%60) had simple skin tags. In these
patients, the skin tags were most commonly
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Discussion
Acromegaly is associated with an increased
prevalence of neoplastic disorders (10). The results
of several studies indicate that the frequency of
colorectal cancer increased in patients with
acromegaly (4,6,10). Adenomatous polyps are the
precursor lesions of colonic cancer (2). The removal
of adenomatous polyp before it becomes malignant
will be benefical for the actual prevention of
colonic cancer (10). Skin tags are usually benign
and the prevalence of these lesions increase in
elderly patients (7). An association between skin
tags and colonic polyps in acromegalic patients has
also been reported (8,9,11). Thus, skin tag may be
a marker for the colonic polyps in patients with
acromegaly. Leavit et al. demonstrated a relation
between the skin tag and the precence of colonic
polyp in male patients (8). In this study, they found
that the sensitivity for skin tags in identifying
patients at risk for colonic polyps is 80.4% and the
ORIGINAL ARTICLE
spesificity is 77.1%. In another study, Bhansali et
al. showed that the number of skin tags was
significantly higher in the group of acromegalic
patients with colon polyps. The study of Beitler et
al. showed high insidence of colonic polyps in
patients with skin tag (11). Our study shows that
real positivity ratio is high and specifity ratio is
%80. We couldn’t verify this result at the Fischer’s
exact test because number of patients were
insufficent. Insufficiency generated from the strict
criteria applied in choosing the patients. In conclusion,
acromegalic patients with skin tags have an
increased risk of developing colonic polyps. If we
consider potential cancer risk of the polyp, removal
of the polyp will reduce the risk of malignancy. As
a result of our study we conclude that colonoscopy
should be performed in all acromegalic patients
especially in those with skin tags.
4. Vasen HF, van Epercum KJ, Roelfsma F, Raue F,
Koppeschaar H, Griffioen G, van Berge Henegouwen GP.
Increased prevalence of colonic adenoma in patients with
acromegaly. Eur J Endocrinol. 131:235-237, 1994.
5. Martino A, Cammarota G, Cianci R, Bianchi A, Sacco E,
Tilaro L, Marzetti E, Certo M, Pirozzi G, Fedeli P,
Pandolfi P, Pontecorvi A, Gasparrini G, De Marinis L.
High prevalence of hyperplastic colonic polyps in
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6. Terzolo M, Tappero G, Borretta G, Asnaghi G, Pia A,
Reimondo G, Boccizzi A, Cesario F, Rovero E, Paccotti P
et al. High prevalence of colonic polyps in patients with
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Skin Tags: A cutaneous marker for colonic polyps. Ann
Intern Med. 98: 928-930, 1983.
9. Bhansali A, Kochhar R, Chawla YK, Reddy S, Dash RJ.
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