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The Pemberton and Maroni Signs
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Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
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TO THE EDITOR:
Drs. Wallace and Siminoski [1] have written a wonderful case report on the usefulness of the Pemberton sign as a physical diagnostic maneuver for detecting substernal goiter. The accompanying dramatic color photographs will no doubt leave readers with an indelible image. However, an additional uncommon physical finding can be seen in the photograph of the patient with his arms in the downward position. The erythema of the skin directly overlying the thyroid gland is termed the Maroni sign and is found in patients with hyperthyroidism [2]. The erythema is often seen in the discrete contour of the thyroid gland and may be associated with pruritus. Therefore, this patient with a suppressed thyroid-stimulating hormone level may have been given a diagnosis of hyperthyroidism and substernal goiter on the basis of clinical examination without any additional studies.
Paul G. Auwaerter, MD
Johns Hopkins University School of Medicine; Lutherville, MD 21093
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
