The literature mentioned that another hormone abnormality can cause C.V.G.: acromegaly. This disorder is caused by an abnormal growth on the pituitary gland of the brain, a tumor that makes excess growth hormone. As a medical student, Mathis had been taught to recognize the disorder by looking for features of the most famous patient in his lifetime with acromegaly, Andr Ren Roussimoff, best known by the name he adopted first in his wrestling career and later as an actor: Andr the Giant. And he was a giant: 7-foot-4 and weighing over 500 pounds. His face, well known to so many of us thanks to his role as Fezzik, the kind giant in Rob Reiners classic movie The Princess Bride, serves as a template for the effects of acromegaly. The excess growth hormone causes enlargement of the soft tissues of the face, including the ears, the nose and the tongue, as well as the soft tissues of the hands and feet. Untreated, this kind of tumor causes premature death.

Mathis looked at the patient not just his skin but the whole person. He was a big man, over six feet tall and weighing more than 250 pounds. He had prominent ears and a large nose. Even his tongue was large. Acromegaly was certainly possible. He asked the patient if he had noticed any changes in the size of his feet or hands over the past few years. He certainly had, the man answered promptly. A few years ago, he and his wife replaced the wedding rings they bought each other when they married and didnt have much money, and he needed a bigger ring. And his feet were growing, too. He used to wear a size 12 but now needed size 14. He figured it was because he was getting fatter. He had put on 75 pounds since their wedding day.

The dermatologist explained his thinking. He had never made a diagnosis of acromegaly and quickly looked up how to do it. The first step was to check the level of one of the growth factors usually stimulated by this kind of brain tumor. If that was high, the patient would need imaging of his brain to look for a tiny tumor on the pituitary gland. The blood test took days to come back. It was abnormal. And the CT scan revealed a growth about the size of a lima bean on his pituitary. Mathis referred the patient to a neurosurgeon, who removed the tumor. He didnt see the patient again until the following year. By then, the patient reported, his fingers and nose had gotten smaller, and his gratitude to the young doctor had grown. Mathis was thrilled with his diagnosis. Im curious, he told me recently, and that has been one of his most reliable and valuable tools as a doctor. And hes not ashamed to have to look things up.

Two years have passed since the patient had his operation, and he and his wife have watched with interest as the mans former face emerged. The lumpy scalp is unchanged, but his wife was particularly happy to welcome her husbands old nose back. He is starting to lose his hair maybe it needed the excess growth hormone to stay but, his wife told me, she considers that a small price to pay.

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.Sandersmd@gmail.com.

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What Was Causing the Strange Grooves in the Mans Scalp? - The New York Times

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