Check old photos
Not so fast, Cantero warned. First, they needed to see if the tumor was making one of the hormones in the pituitary gland. Doctors suspected that the patient was overdose on one of these hormones. Overproduction of growth hormone causes a disorder called acromegaly, a disordered expansion of soft tissues throughout the body. The patient was a small woman, but the doctor noticed that her hands and feet were huge. Can you take down the mask? Cantero asked. And can you show me the old photos? The difference between the two faces was added to the clinical suspicion of Cantero. But such a diagnosis requires more than suspicion. Cantero sent the patient to the laboratory, where half a dozen blood tubes were collected and sent out. She returned to the endocrinologist’s office two weeks later. Her growth hormone levels were almost five times higher than they should be. She had acromegaly. The woman had surgery two weeks later.
Acromegaly is rare. It is most extreme when over-secretion of hormones begins before puberty and bones can still grow. Andre the Giant, well known as Andre the Giant, was 7 feet 4 when he finally stopped growing tall. After puberty, when bone growth ceases, only soft tissue enlarges. Still, it can cause serious changes in appearance and health. Patients with untreated acromegaly often suffer from obstructive sleep apnea due to weakness, with enlargement of mouth and throat tissue, hypertension, joint destruction, and sometimes cardiac enlargement. This patient was found to have everything but cardiac hypertrophy.
Immediately after receiving this diagnosis, the patient began reading about the illness. If asked before her diagnosis was made, the only symptom she would have identified was a bent jaw. Reading about the experiences of others, she said that many of the frustrations and medical problems she experienced were due to this excess growth hormone, and as she assumed, menopause was an active life and aging. I realized that it wasn’t due to the effects on my body. She saw a change in her face. Her hands were so big that she couldn’t put on the ring. Her legs were huge. For most of her adult life, she wore shoes of size 8½. By the time she had surgery, her legs were very wide and she wore a male size 9½. Her tongue was so big that she often bit it, and she had sleep apnea. She also had high blood pressure.
She was thin for the rest of her life, but at the age of 49 she needed a knee arthroplasty. She was always sweating her hot and crazy. Menopause, she thought — until she read about this tumor.
Two days after discharge, she was able to fit 8½ female-sized mother’s shoes. She is no longer always hot and sweaty. Sounds trivial, but it was one of the worst parts of the whole test. And one year after her surgery, she told me she looked at least five years younger. Her acquaintance suspects a facelift. Her friend knows it was another type of surgery. Best of all, she has seen her face slowly returning to her familiar face.
Lisa Sanders, MD is a magazine contributor. Her latest book is “Diagnosis: Solving the Most Troublesome Medical Mysteries”. If you have a resolved case to share, write her to Lisa.Sandersmdnyt@gmail.com.
