Endocrine Abstracts

Introduction: Aurantiasis cutis is an asymptomatic condition characterised by yellow discolouration of the skin and is caused by high levels of β-carotene. Beta carotenaemia has frequently been associated with the development of menstrual disturbances in women but no causal link has been established.

Case report: We herein present a case of a 15 year old Caucasian girl (otherwise well, BMI 24) who presented with aurantiasis cutis together with a four month history of secondary amenorrhoea. Menarche was at the age of 12 and her cycle had been regular. Hyperbilirubinaemia was excluded and she had a normal renal and lipid profile and normal adrenal and thyroid function. She exercised regularly, consistently training up to ten hours a week for the regional hockey team. Despite being rich in fruit, vegetables and protein, her diet that was too ‘healthy’ as it was insufficient for her high energy expenditure and comprised on average 1700 kcal/day, 87% and 72% of the recommended fat and carbohydrate intake respectively. Her test results are shown in the table;

Biochemistry results show low levels of gonadotrophins and oestradiol consistent with a diagnosis of hypogonadotrophic hypogonadism. As well as a raised β-carotene she had raised levels of lycopene, lutein and cryptoxanthin which all come from green leafy vegetables. Beta carotenaemia is most commonly caused by excessive dietary intake of β-carotene rich foods or dietary supplements. It can also be caused by diabetes mellitus, hypothyroidism, nephrotic syndrome, liver disease and a failure of enzymatic conversion of carotene to vitamin A.

Discussion and conclusions: The patient was found to have functional hypothalamic amenorrhoea resulting from insufficient calorie intake and excessive exercise. The patient’s yellow skin was a result of β-carotenaemia due to excessive intake of raw vegetable and fruit. Although there are previous reported cases of adult patients with both presentations occurring together, no causal link has been established and are most likely related to the patient’s lifestyle. Dietetic counselling has been provided and follow up is ongoing.