Checking an old picture
Not so fast, Cantero warned. First we need to see if the tumor is producing pituitary hormones. The doctor suspected that the patient had an overdose of one of these hormones – an overproduction of growth hormone that causes uncontrolled growth of soft tissues throughout the body, a disorder called acromegaly. The patient was a small woman, but, the doctor noticed, her arms and legs were huge. Can you take off your mask? Cantero asked. And show me an old picture? The difference between the two faces adds 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. He returned to the endocrinologist’s office two weeks later. Her growth hormone levels should have been about five times higher: she had acromegaly. The woman underwent surgery two weeks later.
Acromegaly is rare. This is most extreme when excess hormone secretion begins before puberty, when the bones can still grow. Andre Rusimoff, known as Andre the Giant, was 7-foot-4 when he finally stopped growing taller. After puberty, when bone growth stops, only the soft tissues will grow. It can still cause serious changes in appearance and health. If left untreated, acromegaly patients often develop sleep apnea, which can lead to tissue growth in the mouth and throat, hypertension, joint fractures, and sometimes an enlarged but weak heart. This patient, it turned out, had everything except an enlarged heart.
Upon receiving this diagnosis, the patient immediately begins to read over the disease. If asked before his diagnosis, his only symptom is a crooked jaw. Reading other people’s experiences, he realized how many of the annoying and medical problems he was dealing with were due to this extra growth hormone and, as he did not realize, from the effects of menopause on an active life and aging body. She noticed a change in his appearance. Her hand was so big that she could not wear the ring. Her legs were huge. For most of his adult life, he wore 8½ size shoes. At the time of his surgery, his legs were so wide that he wore a men’s size 96. His tongue was so big that he would bite often and he had sleep apnea. He also had high blood pressure.
He was thin for the rest of his life but at the age of 49 he needed a knee replacement. She was hot all the time and sweating like crazy. Menopause, he thought – until he read about this tumor.
Two days after leaving the hospital, he can fit in his mother’s shoes, a woman’s size 8½. She is no longer hot and sweating all the time. It sounds trivial, he told me, but it 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. His acquaintances suspect face lift. His friends knew it was a different kind of surgery. After all, he noticed that his face was slowly returning to the one he knew so well.
Lisa Sanders, MD, is a contributing writer for the magazine. Her latest book is “Diagnosis: The Solution to the Most Confusing Medical Mystery.” If you have a case to resolve, please write to [email protected]