Letter to the Editor
Comments on “Hipercarotinemia after bariatric surgery”
Comentarios sobre «Hipercarotinemia tras cirugía bariátrica»
Patricia Soblechero Martin
, Fernando Granado Lorencio, Encarnación Donoso Navarro, M. Ramona de los Ángeles Silvestre Mardomingo
Corresponding author
Servicio de Bioquímica Clínica, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
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=> "Comments on “Hipercarotinemia after bariatric surgery”" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">Sir</span>," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "374" "paginaFinal" => "375" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Patricia Soblechero Martin, Fernando Granado Lorencio, Encarnación Donoso Navarro, M. Ramona de los Ángeles Silvestre Mardomingo" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Patricia" "apellidos" => "Soblechero Martin" "email" => array:1 [ 0 => "patriciasoblechero@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Fernando" "apellidos" => "Granado Lorencio" ] 2 => array:2 [ "nombre" => "Encarnación" "apellidos" => "Donoso Navarro" ] 3 => array:2 [ "nombre" => "M. Ramona de los Ángeles" "apellidos" => "Silvestre Mardomingo" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Bioquímica Clínica, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Comentarios sobre «Hipercarotinemia tras cirugía bariátrica»" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The article «Hypercarotinemia after bariatric surgery», published by Gutiérrez-Medina, S. et al.,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> reports the case of a patient with possible hypercarotinemia secondary to vitamin A supplementation after bariatric surgery who attended the emergency room for probable carotenodermia. This case attracted our interest because of the uncommon occurrence of this condition in clinical practice, its unexpected finding in a patient with probable malabsorption after bariatric surgery, and the interpretation and diagnosis based on the parameters reported (“hypercarotinemia secondary to treatment with vitamin A”). In this context, we would like to refer to some points that could contribute to clarify these findings.</p><p id="par0010" class="elsevierStylePara elsevierViewall">First of all, the term «hypercarotinemia» appearing in the title as referring to the diagnosis of the patient does not appear to be adequate, because it refers to an increase in blood carotenoid levels (>300<span class="elsevierStyleHsp" style=""></span>μg/dL),<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> and no reference is made in the article to any measurement of carotenoid levels during the follow-up of the patient.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Second, the orange-yellow pigmentation of the skin reported in this patient (possible carotenodermia or palmoplantar xanthosis) is a secondary disorder associated with hypercarotinemia (rather than hypervitaminosis A), although high blood carotenoid levels are not always associated with carotenodermia. This reversible pigmentation is due to the deposition in the horny layer of carotenoids, which become most evident in the soles of the feet, the palms of the hands, the forehead, and the nasolabial folds.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> The cause is, in most cases, due to the excess consumption of carotenoids in the diet or in food supplements, although the deposition may also occur in some diseases (e.g. diabetes mellitus, hypothyroidism, anorexia nervosa). Moreover, in contrast to the usual homogeneous and bilateral (in both hands and legs) presentation of carotenodermia, pigmentation in the reported case showed color to be especially concentrated in the fingers and only appeared on the palm of one hand, which is extremely unusual in the literature.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">3–5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Finally, the diagnosis appears to relate palmar pigmentation to hypercarotinemia secondary to hypervitaminosis A, as the patient had symptoms consistent with vitamin A toxicity. Two facts should be mentioned in this regard: (1) blood retinol levels did not exceed the normal range at any time, and were even below the lower limit, i.e. they suggested a deficiency, and high levels of retinyl ester forms (a potential marker of toxicity) were not reported either<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a>; and (2) while some carotenoids may be converted into retinol, humans cannot synthesize carotenoids de novo or from retinol.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In the case reported, the carotenodermia seen should be associated with excess blood carotenoids resulting from a high intake and, possibly, a blockade in the conversion to retinol due to vitamin A overdosing. Unfortunately, carotenoid intake was not measured, and excess absorption is unlikely because of the malabsorption derived from bariatric surgery.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">8,9</span></a> Therefore, because of the lack of information on blood carotenoid levels, and the biochemical criteria suggesting vitamin A toxicity,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> the diagnosis should be reconsidered.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Soblechero Martin P, Granado Lorencio F, Donoso Navarro E, Silvestre Mardomingo MRÁ. Comentarios sobre «Hipercarotinemia tras cirugía bariátrica». Endocrinol Nutr. 2016;63:374–375.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hipercarotinemia tras cirugía bariátrica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Gutiérrez-Medina" 1 => "P. Iglesias Bolaños" 2 => "A. Paniagua Ruíz" 3 => "M.B. Martínez-Barbeíto" 4 => "L. 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| 2023 August | 27 | 2 | 29 |
| 2023 July | 37 | 7 | 44 |
| 2023 June | 18 | 1 | 19 |
| 2023 May | 21 | 7 | 28 |
| 2023 April | 8 | 3 | 11 |
| 2023 March | 19 | 0 | 19 |
| 2023 February | 26 | 3 | 29 |
| 2023 January | 24 | 6 | 30 |
| 2022 December | 22 | 4 | 26 |
| 2022 November | 31 | 3 | 34 |
| 2022 October | 42 | 14 | 56 |
| 2022 September | 27 | 7 | 34 |
| 2022 August | 26 | 9 | 35 |
| 2022 July | 17 | 11 | 28 |
| 2022 June | 13 | 9 | 22 |
| 2022 May | 25 | 9 | 34 |
| 2022 April | 12 | 4 | 16 |
| 2022 March | 26 | 8 | 34 |
| 2022 February | 19 | 5 | 24 |
| 2022 January | 22 | 6 | 28 |
| 2021 December | 22 | 16 | 38 |
| 2021 November | 26 | 10 | 36 |
| 2021 October | 17 | 9 | 26 |
| 2021 September | 11 | 20 | 31 |
| 2021 August | 10 | 9 | 19 |
| 2021 July | 17 | 12 | 29 |
| 2021 June | 19 | 8 | 27 |
| 2021 May | 18 | 9 | 27 |
| 2021 April | 28 | 10 | 38 |
| 2021 March | 13 | 11 | 24 |
| 2021 February | 16 | 6 | 22 |
| 2021 January | 12 | 12 | 24 |
| 2020 December | 12 | 9 | 21 |
| 2020 November | 15 | 11 | 26 |
| 2020 October | 12 | 6 | 18 |
| 2020 September | 18 | 37 | 55 |
| 2020 August | 12 | 26 | 38 |
| 2020 July | 10 | 7 | 17 |
| 2020 June | 8 | 5 | 13 |
| 2020 May | 19 | 12 | 31 |
| 2020 April | 17 | 4 | 21 |
| 2020 March | 20 | 11 | 31 |
| 2020 February | 13 | 9 | 22 |
| 2020 January | 22 | 9 | 31 |
| 2019 December | 22 | 7 | 29 |
| 2019 November | 17 | 3 | 20 |
| 2019 October | 15 | 3 | 18 |
| 2019 September | 11 | 7 | 18 |
| 2019 August | 10 | 7 | 17 |
| 2019 July | 18 | 27 | 45 |
| 2019 June | 22 | 25 | 47 |
| 2019 May | 93 | 32 | 125 |
| 2019 April | 6 | 14 | 20 |
| 2019 March | 11 | 2 | 13 |
| 2019 February | 12 | 5 | 17 |
| 2019 January | 9 | 3 | 12 |
| 2018 December | 7 | 6 | 13 |
| 2018 November | 10 | 3 | 13 |
| 2018 October | 8 | 3 | 11 |
| 2018 September | 13 | 6 | 19 |
| 2018 August | 12 | 3 | 15 |
| 2018 July | 4 | 1 | 5 |
| 2018 June | 11 | 1 | 12 |
| 2018 May | 6 | 1 | 7 |
| 2018 April | 13 | 2 | 15 |
| 2018 March | 12 | 1 | 13 |
| 2018 February | 7 | 1 | 8 |
| 2018 January | 17 | 1 | 18 |
| 2017 December | 8 | 0 | 8 |
| 2017 November | 16 | 1 | 17 |
| 2017 October | 16 | 1 | 17 |
| 2017 September | 15 | 4 | 19 |
| 2017 August | 12 | 0 | 12 |
| 2017 July | 22 | 1 | 23 |
| 2017 June | 11 | 3 | 14 |
| 2017 May | 17 | 9 | 26 |
| 2017 April | 15 | 4 | 19 |
| 2017 March | 21 | 55 | 76 |
| 2017 February | 45 | 6 | 51 |
| 2017 January | 0 | 3 | 3 |
Show all
