Checking an old photo
Not so fast, Cantero warned. First they had to see if the tumor was producing one of the pituitary hormones. The doctor suspected that the patient had an excess of one of these hormones – an overproduction of growth hormone will cause an unregulated enlargement of the soft tissues throughout the body, a condition called acromegaly. The patient was a short woman, but, the doctor noted, her hands and feet were huge. Can you take off your mask? asked Cantero. And show me an old photo? The difference in the two faces contributed to Cantero’s clinical suspicion. But such a diagnosis requires more than suspicion. Cantero sent the patient to the lab, where half a dozen tubes of blood were drawn and sent. Two weeks later, she returned to the endocrinologist’s office. Her growth hormone levels were almost five times what they should be: She had acromegaly. The woman was operated on two weeks later.
Acromegaly is rare. It is most extreme when the hormone oversecretion begins before puberty, when bones can still grow. André Roussimoff, better known as André de Reus, was six feet tall when he finally stopped growing. After puberty, when bone growth stops, only the soft tissues will enlarge. That can cause serious changes in appearance and health. Left untreated, patients with acromegaly will often have obstructive sleep apnea due to enlargement of the tissues in the mouth and throat, high blood pressure, joint breakdown, and sometimes an enlarged but weakened heart. This patient, it turned out, had everything but the enlarged heart.
After receiving this diagnosis, the patient immediately began to learn about the disease. If asked before her diagnosis, the only symptom she would have identified was the crooked jaw. Reading about other people’s experiences, she realized how much of the irritations and medical problems she’d been going through came from this excess of growth hormone and not, as she had believed, from the effects of menopause on an active life and an aging body. She had seen changes in her face. Her hands were so big she couldn’t wear rings. Her feet were huge. She wore a size 8 shoe for most of her adult life. By the time she had surgery, her feet were so wide that she was wearing a men’s size 9½. Her tongue was so big that she often bit into it, and she had sleep apnea. She also had high blood pressure.
She was skinny all her life, but had to have a knee replacement at 49. She was hot all the time and sweating like crazy. Menopause, she thought—until she read about this tumor.
Two days after she left the hospital, she was able to fit into her mother’s shoes, a women’s size 8½. She is no longer hot and sweaty all the time. It sounds insignificant, she told me, but that was one of the worst parts of the whole ordeal. And a year after her surgery, she tells me she looks at least five years younger. Her acquaintances suspect a facelift. Her friends know it was a different kind of surgery. Best of all, she’s watched her face slowly return to the face she knew so well.
Lisa Sanders, MD, is a contributing writer for the magazine. Her latest book is “Diagnosis: Solving the Most Baffling Medical Mysteries.” If you have a resolved case to share, write to [email protected].