To the Editor.—
In his article in the February 1985 Archives, Ober1 rightfully contends that the relationship between acanthosis nigricans and hypothyroidism has not been convincingly established, yet he has chosen a title that would lead one to believe that such a relationship exists, when there is no evidence in the article to support that assumption.From the discussion of the case, it becomes apparent that the "hidden," but perhaps the strongest, variable was the patient's obesity, which would explain both the acanthosis nigricans and the insulin resistance. This point was explicitly brought out in the accompanying editorial by Flier.2 Furthermore, Ober mentions that hypothyroidism is usually associated with hypoinsulinemia, based on the study of Shah and Cerchio.3 It may be a misleading assertion, since Shah and Cerchio's study demonstrated only a deficient phase-I insulin release, while the phase-II insulin release was well preserved. Studies of animals
Khardori R. Hypothyroidism, Insulin Resistance, and Acanthosis Nigricans. Arch Dermatol. 1985;121(8):967. doi:10.1001/archderm.1985.01660080021003
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