BEDSIDE ASSESSMENT OF SKIN-FOLD THICKNESS - A USEFUL MEASUREMENT FOR DISTINGUISHING CUSHINGS-DISEASE FROM OTHER CAUSES OF HIRSUTISM AND OLIGOMENORRHEA

Background: The known catabolic effects of glucocorticoid excess on pr otein metabolism prompted us to devise a method to assess this measure in reproductive-aged females with Cushing's disease. Since collagen p rotein is a major component of skin, decreased abundance of this prote in should cause a reduction in skin-fold thickness. To determine wheth er skin-fold thickness is useful as an added tool in the diagnosis of Cushing's disease, we compared this value in female patients with Cush ing's disease with those who presented with a similar set of symptoms. Methods: This open prospective study was conducted in an endocrinolog y clinic at a tertiary care center. The study population consisted of 88 females in the reproductive age group who presented to the clinic w ith hirsutism, oligomenorrhea, and/or obesity. Measurement of skin-fol d thickness, body mass index, Ferriman-Gallwey index, and serum testos terone were performed in all patients. Results: Skin-fold thickness in the patients with Cushing's disease was 1.5+/-0.2 mm (range, 1.0 to 1 .8 mm). This value was significantly (P<.01) lower than that in contro ls or subjects with other disorders that have a similar set of present ing symptoms. Conclusions: Bedside assessment of skin-fold thickness i s an easy, low-cost, and noninvasive test for distinguishing Cushing's disease from disorders with similar presenting symp toms in females o f reproductive age. Assessment of skin-fold thickness should be used a s an adjunct to current physical and biochemical study of patients wit h symptoms suggestive of Cushing's disease.