Sarcoidosis of the skin - is the second most common form of this systemic disease. Sarcoidosis can affect a variety of organs and body systems. Simultaneously, the skin may be affected lymph nodes Lymph nodes - what keeps our immune system , Lungs, liver, spleen, nervous system and even the heart. Therefore, detection of skin sarcoidosis patient should be fully examined.

Cutaneous sarcoidosis - why it begins

Why the skin begins sarcoidosis is unknown. Previously, this disease was considered a form of tuberculosis. Today, it is known that tuberculosis is not related, but tuberculosis Tuberculosis - a full recovery is not guaranteed   It can be attached to it.

The main cause of sarcoidosis (including sarcoidosis skin) modern scholars believe the hereditary characteristics of immunity Immunity - types and characteristics in children in adults   - Its ability to respond in a certain way or another impact. Thus, in order to originated sarcoidosis Sarcoidosis - how to protect themselves? You need a few reasons. On participation in its development of hereditary factors suggest familial forms of the disease.

This woman sarcoidosis of the skin (and all other forms of sarcoidosis) get sick more often than men. The disease develops mostly in the age of 20-40 years.

What are the symptoms of sarcoidosis skin

A typical manifestation of sarcoidosis are inflammatory lung nodules - granulomas. Cutaneous sarcoidosis granulomas are located in the middle and deep layers of the skin and called sarcoid Beck - on behalf of the Norwegian dermatologist who first described them in the late 19th century.

Ts.Bek described three types of sarcoids - scattered melkouzelkovye rashes and krupnouzlovaty and diffuse infiltrative appearance sarcoids. Today, well-known and other skin manifestations of sarcoidosis: Chilblains lupus Besnier-Tennesona, angiolyupoid Brock Potro and subcutaneous sarcoid Darier-Roussy.

The cutaneous manifestations of sarcoidosis are combined with the involvement of other tissues and organs, but there are also isolated. Disease often begins gradually: first appear on the skin sarcoid isolated, but gradually their number increased.

Melkouzelkovy sarcoid

Melkouzelkovy sarcoid looks like clearly delimited with a bluish tint reddish or brick-red nodules the size of 5-6 mm. The surface is smooth nodules, sometimes it is a little flaky. Plotnovata nodules or hard to the touch, painless, located on the face, upper torso (a cape) and the extensor surfaces of hands.

Over time, the nodules are flattened in their place are small dark spots or skin atrophy (decrease in volume) surrounded by pigmented rim. Eruptions appear episodic, between attacks may take place months or years.

Krupnouzelkovy sarcoid

Krupnouzelkovy sarcoid - a single (their is no more than a dozen) protruding above the skin nodules larger than melkouzelkovye elements (they can reach 1-2 cm in diameter), brownish or reddish-bluish color. Sarcoid are located mainly in the face and neck, less - on hand in the groin area and lower extremities. On the surface there are whitehead (whiteheads, resulting from the increased activity of the sebaceous glands) and telangiectasia (persistent dilation of small blood vessels, visible as a red spot on the skin).

Sarcoid skin over smooth or slightly scaly, with its probing the pain is not detected. Krupnouzelkovye arkoidy may remain unchanged for years, but may be subject to reciprocal and development. In this case, in their place are brown or white spots surrounded by towering ring brownish skin. During exacerbation of these rings often appear melkouzelkovye sarcoid.

Other sarcoids

Sometimes krupnouzelkovy sarcoid has the form of single patches of soft consistency with a lot of telangiectasia. Such elements are called Broca angiolyupoida Potro. Eruptions are placed on the forehead, the side surfaces of the upper part of the nose, have a bluish color with a brownish tint.

Diffuse infiltrative form of cutaneous sarcoidosis is not as common and is characterized by the formation of mild delineated infiltrative lesions rather compact texture, brownish-bluish color, diameter of 10-15 cm and more.

When Chilblains lupus Besnier-Tennesona on the skin of the cheeks, nose, ears, chin and forehead appear clearly demarcated from healthy tissue red-purple flat or slightly convex without peeling lesions and atrophy, which leaves no scarring.

Even more rarely, can be seen subcutaneous sarcoid Darier-Roussy - subcutaneous nodules as small as a walnut, dense, painless, prone to mergers and the formation of large infiltrations. Located such nodes on the sides of the torso, abdomen and thighs.

Treatment of sarcoidosis of the skin is carried glucocorticoid hormones that are assigned, both internally and externally, in the form of ointments and creams. Treatment long, it may take several months.

Galina Romanenko

  Most of the tumors formed in the pituitary adenomas are. Pituitary adenoma - a benign tumor that forms from the pituitary cells, and growing, as a rule, very slowly. The pituitary gland is located at the base of the brain, behind the eye. It is considered the main glands of the body (one of the names of the pituitary gland - pituitary gland), responsible for regulating the hormonal levels.

Pituitary adenoma: Physiology

Pituitary tissue composed of several cell types, each of which produces certain hormones, which in turn enter the bloodstream, and affect different organs.

Pituitary adenomas are derived from any one type of cell. Tumor cells which produce excessive amounts of one or more hormone called function adenomas. One variation of such tumors is prolactinoma - a pituitary adenoma that results in excessive production of prolactin. If, due to an adenoma produces too much growth hormone, it can cause the development of acromegaly (in adults) or gigantism (in children). Cushing's disease can begin to develop in the case of pituitary adenoma stimulates the production of excessive amounts of cortisol.

Pituitary adenomas that do not release active hormones, called non-functional adenomas.

Incidence

However, most of these tumors are not practically do not grow and do not cause any problems. Most pituitary adenoma detected when a person makes magnetic resonance imaging (MRI) of the brain assigned to the diagnosis of any other disease.

The types of pituitary adenomas

Pituitary adenomas can be classified in several ways, depending on the following properties:

• Resolution. Pituitary adenoma, diameter of less than one centimeter, called microadenomas; if the diameter of an adenoma greater than one centimeter, it is called macroadenomas.
• Aggressiveness. Almost all adenomas are benign and grow slowly. More rare variety adenoma - atypical pituitary adenoma - is growing quite rapidly, and can reappear after treatment. Pituitary carcinomas - malignant tumors that could potentially spread to other parts of the body are extremely rare.
• Secretion of hormones. Pituitary adenomas that produce hormones (usually in excessive amounts), called functional or hormonally active adenomas. Adenomas, which do not produce hormones are nonfunctional adenomas.

Causes

Most pituitary adenomas develop spontaneously, that there is a predisposition to their appearance is not inherited.

There are cases of congenital predisposition to the formation of pituitary adenomas, but this is quite rare. Typically, in such cases, patients also have a tendency to development of gigantism or acromegaly.

Wermer syndrome, or multiple endocrine neoplasia type 1 (MEN1) - a rare disorder in which tumors develop simultaneously in the pituitary gland, pancreas, and parathyroid gland. Pituitary adenomas develop in approximately 25% of people diagnosed with MEN1.

Symptoms

In patients with hormonally active pituitary adenomas symptoms usually associated with the impact of certain hormones in the body.

Nonfunctional pituitary adenomas tend to cause problems relating to the size of the tumor, which can put pressure on the adjacent brain structures.

Large pituitary adenomas may press on the optic nerves perekrestov, which in some cases leads to problems with vision, until the loss of vision. Pituitary adenoma large size may also put pressure on the pituitary gland itself, which is why his work can be broken. Therefore, patients who have been identified pituitary adenoma, you must undergo a thorough medical examination in which the doctor will determine how well the pituitary gland.

Sometimes, too, functional adenomas grow to large sizes and cause the same problems as the major non-functional adenomas - in addition to the symptoms associated with increased levels of hormones in the body.

Symptoms caused by the hormonally active pituitary adenomas

Prolactinoma. Excess prolactin in women can lead to the cessation of menstruation and to reduce the production of breast milk during lactation. In males, increased prolactin levels may cause a decrease in testosterone levels, which leads to a weakening of libido and other effects.

Pituitary adenoma that produces growth hormone. The secretion of too large amounts of growth hormone may result in the development of adult acromegaly and gigantism in children. Among the symptoms of these disorders - a disproportionate increase in the hands and feet, and other body modifications.

Pituitary adenoma that produces adrenocorticotropic hormone. The excess of adrenocorticotropic hormone (ACTH) may lead to Cushing's disease. Its main symptoms are unwarranted weight gain, bruising on the body, often - for no apparent reason, and muscle weakness.

Pituitary adenoma, secretes thyroid stimulating hormone (tireotropinoma). Increased levels of thyroid stimulating hormone (TSH) leads to the development of hyperthyroidism Hyperthyroidism: increased secretion of thyroid hormone With its symptoms such as sudden weight loss, sweating, sleep problems Dreams: how to understand our dreams , and others. Pituitary adenomas of this type are very rare.

Symptoms caused by large pituitary adenomas (macroadenomas)

• Blurred vision. This occurs when the pituitary adenoma sprouts in the upper part of the brain and begins to push perekrestov optic nerves.
• The deterioration of peripheral vision or bitemporal hemianopsia. Patients with severe forms of this disorder can only see what is in front of them. Many people do not realize that their peripheral vision is reduced, until it begins to have a significant impact on quality of life.
• Large pituitary adenoma can cause other eye problems, such as:
• Decreased visual acuity - typically observed in cases where adenoma germinates forward towards the eye and squeezing the optic nerve;
• Violation of color perception - they are starting to look less bright than usual.

In addition, macroadenoma can lead to pituitary insufficiency - we'll talk about it separately.

Symptoms associated with pituitary insufficiency

When the tumor compresses the healthy pituitary gland, it can lead to disruption of its functioning - a condition called pituitary insufficiency. Its symptoms depend on the level of hormones which ones influenced the development of this disorder.

Reduced levels of sex hormones, luteinizing hormone and follicle-stimulating hormone (FSH)

• In men, this leads to a decrease in testosterone levels, which can cause impotence Impotence - a female perspective on the problem   and the weakening of the libido;
• In some cases, men are also a decrease of hair on the face and body;
• In women, lowering levels of these hormones can lead to infertility.

Decreasing the secretion of pituitary TSH deficiency can cause hypothyroidism, whose symptoms are loss of appetite, weight gain, fatigue and impaired mental function.

Lowering the level of ACTH and consequently, a decrease in cortisol secretion causes adrenal insufficiency. Among the symptoms of this condition - fatigue, low blood pressure, electrolyte imbalance. In severe cases, this disorder can lead to death.

Reduction of growth hormone Growth Hormone - Medicine will grow   experts called growth hormone deficiency. In children, it leads to delayed development; As a rule, they puberty occurs later than most peers. In adult growth hormone deficiency is rather weak effect, but among its effects can be permanent general fatigue, loss of muscle mass and decreased muscle tone.

The decrease of prolactin is very rare and occurs in severe pituitary insufficiency.

Large pituitary tumors may slightly increase the level of prolactin in blood. According to doctors, this is due to compression of the pituitary stalk that connects the brain to the pituitary gland.

In women who have not yet menopause, it can lead to the fact that menstruation will become less abundant and more rare, or cease altogether. It can also cause disturbances produce breast milk (galactorrhea).

However, the level of prolactin in pituitary adenoma such increased only slightly (in contrast to the cases where patients develop prolactinoma), disorders and symptoms are usually poorly expressed.

In addition, the pituitary insufficiency can cause regular headaches.

Pituitary apoplexy

The pituitary adenoma may suddenly start bleeding internally, resulting in a sharp increase in its size. In other cases, the tumors become starved of blood flow, and it also leads to the fact that it rapidly increases. The main feature of pituitary apoplexy is usually a strong, sudden headache. If this symptom is accompanied by a sharp deterioration of vision is urgently needed surgical intervention. Pituitary apoplexy sometimes leads to severe pituitary insufficiency, symptoms of which occur a few days or weeks later.