Q J Med 2008; 101:899900

doi:10.1093/qjmed/hcn098 Advance Access published on 31 July 2008

Case report
Clearance of acanthosis nigricans associated with
insulinoma following surgical resection
S. GHOSH, B. ROYCHOWDHURY, S. MUKHOPADHYAY and S. CHOWDHURY
From the Department of Endocrinology, Institute of Post Graduate Medical Education & Research,
Calcutta, India

Acanthosis nigricans is said to be a marker of insulin

resistance. It is known to occur in patients with
insulinoma where there is marked hyperinsulinaemia. We report a case wherein the acanthosis
A 35-year-old gentleman presented with episodes of
blurred vision, confusion, altered consciousness and
seizures, which were relieved on eating. He was
non-diabetic not on any medication and had no
known malignancies. He was obese (BMI = 31kg/m2)
with acanthosis nigricans and skin tags (Figure 1).
During a supervised fast he became symptomatic
and had a plasma glucose of 36 mg/dl and inappropriately high serum insulin (79 mU/ml) and C-peptide
(16 ng/ml) levels. Imaging revealed a mass at the
junction of the head and body of the pancreas
(1.5 cm  1.2 cm). There was no evidence of other
MEN1 tumours.
He underwent surgical enucleation of the mass,
which was then histopathologically confirmed to be
an insulinoma.
His plasma glucose normalized and he remained
symptom free. At 8 weeks (post-op), we noticed that
the acanthosis had disappeared. This had occurred
even before his subsequent significant weight loss.
Blood tests confirmed that his hyperinsulinaemic
state had resolved. [Fasting glucose (85 mgl/dl) and
insulin (6 mU/ml)].
Acanthosis nigricans is associated with
numerous conditions including obesity, type 2

disappeared following surgical resection of insulinoma and this strengthens the hypothesis that
hyperinsulinaemia is responsible for acanthosis.

Figure 1. Acanthosis nigricans.

diabetes, polycystic ovarian syndrome and

insulinoma.1
It is hypothesized that high levels of circulating
unbound insulin binds to IGF-1 receptors on
keratinocytes and fibroblasts and leads to proliferation of epidermis resulting in acanthosis nigricans.2
The resolution of the acanthosis even before
significant weight loss further strengthens our belief
that the surgical resection (with resolution of
hyperinsulinaemia) was responsible for disappearance of the acanthosis.

Address correspondence to S. Ghosh, Department of General Medicine, Ayr hospital, Dalmellington road, Ayr,
South Ayrhire, KA6 6DK, UK. email: drsujoyghosh@rediffmail.com
! The Author 2008. Published by Oxford University Press on behalf of the Association of Physicians.
All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

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Summary

900

S. Ghosh et al.

A similar phenomenon has been described

following partial pancreatectomy in a case of
HAIR-AN syndrome.3

References
1. Matsuoka LY, Wortsman J, Gavin JR, Goldman J. Spectrum
of endocrine abnormalities associated with acanthosis
nigricans. Am J Med 1987; 83:71925.

2. Cruz PD, Hud JA. Excess insulin binding to insulinlike growth factor receptors: proposed mechanism
for acanthosis nigricans. J Invest Dermatol 1992;
98(Suppl. 6):82S5S.
3. Peifer SLE, Wilson RM, Gawkrodger DJ. Clearance of
acanthosis nigricans associated with the HAIR-AN syndrome
after partial pancreatectomy: an 11 year follow-up. Postgrad
Med J 1999; 75:42122.

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