Clinical manifestation

Skin manifestations: diffuse hyperpigmen-tation; lower extremity edema; hypertricho-sis, usually most pronounced over the face, limbs, and chest; sclerodermoid changes; angiomas; whitening of the proximal nails; hepatomegaly; splenomegaly; lymphaden-opathy; abnormal estrogen levels with gynecomastia; hypothyroidism; hyperprol-actinemia; hypoparathyroidism Neurologic manifestations: progressive bilateral symmetric disturbances involving both motor and sensory nerves; begins distally and has progressive proximal spread; osteosclerotic myeloma or monoclonal gammopathy

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