Checking an Old Photo
Not so fast, Cantero warned. First, they needed to see if the tumor was making any of the pituitary’s hormones. The doctor suspected the patient had an excess of one of these hormones — an overproduction of growth hormone will cause unregulated enlargement of the soft tissues throughout the body, a disorder called acromegaly. The patient was a small woman, but, the doctor noticed, her hands and feet were huge. Can you take your mask down? Cantero asked. And show me an old photo? The difference in the two faces added to Cantero’s clinical suspicion. But a diagnosis like this requires more than suspicion. Cantero sent the patient to the lab, where a half dozen tubes of blood were drawn and sent off. She returned to the endocrinologist’s office two weeks later. Her growth-hormone levels were nearly five times what they should be: She had acromegaly. The woman had surgery two weeks later.
Acromegaly is rare. It is most extreme when the oversecretion of the hormone starts before puberty, when bones can still grow. André Roussimoff, more familiarly known as André the Giant, was 7-foot-4 when he finally stopped growing taller. After puberty, when bone growth stops, only soft tissues will enlarge. That can still cause serious changes in appearance and in health. Untreated, patients with acromegaly will often have obstructive sleep apnea from enlarging 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 except the enlarged heart.
After getting this diagnosis, the patient immediately started reading up on the disease. If asked before her diagnosis was made, the only symptom she would have identified was the crooked jaw. Reading about other people’s experiences, she realized how many of the irritations and medical issues she’d been through were from this excess of growth hormone and not, as she had assumed, from the effects of menopause on an active life and an aging body. She’d seen changes in her face. Her hands were so big she couldn’t wear rings. Her feet were enormous. For most of her adult life, she wore a size 8½ shoe. By the time she had her surgery, her feet were so wide she wore a men’s size 9½. Her tongue was so large that she often bit it, and she had sleep apnea. She also had high blood pressure.
She was thin for her entire life but needed a knee replacement at 49. She was hot all the time and sweated like crazy. Menopause, she figured — until she read about this tumor.
Two days after leaving the hospital, she could fit into her mother’s shoes, a woman’s size 8½. She’s no longer hot and sweaty all the time. It sounds minor, she told me, but that was one of the worst parts of the whole ordeal. And a year after her surgery, she tells me that she looks at least five years younger. Her acquaintances suspect a face lift. Her friends know it was a different kind of surgery. Best of all, she has watched as her face has slowly reverted back to the one she knew so well.
Lisa Sanders, M.D., is a contributing writer for the magazine. Her latest book is “Diagnosis: Solving the Most Baffling Medical Mysteries.” If you have a solved case to share, write her at Lisa.Sandersmdnyt@gmail.com.