What Caused Strange Grooves on the Man’s Scalp?


The literature has mentioned that another hormone abnormality can cause CVG: acromegaly. This disorder is caused by an abnormal growth in the pituitary gland of the brain, a tumor that produces excess growth hormone. As a medical student, Mathis was taught to recognize the disorder by looking for features of André René Roussimoff, the most famous acromegaly sufferer during his lifetime. Giant Andrew. And he was a giant: 7 feet-4 and over 500 pounds. Rob Reiner’s face, familiar to many of us with his role as the genre giant Fezzik in the classic movie “The Princess Bride,” serves as a template for the effects of acromegaly. Excess growth hormone causes enlargement of the soft tissues of the hands and feet, as well as the soft tissues of the face, including the ears, nose, and tongue. Untreated, this type of tumor causes premature death.

Mathis looked after the patient – not just his skin, but the whole person. He was a burly man, over one and a half feet tall and weighing more than 250 pounds. He had prominent ears and a large nose. Even his tongue was big. 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. There certainly was, the man replied immediately. A few years ago, he and his wife exchanged the wedding rings they bought each other because they were married and didn’t have much money, and he needed a bigger ring. And his feet were getting bigger too. She used to wear a size 12, but now she needs a size 14. He thought it was because he was getting fatter. She had lost 75 pounds since her wedding day.

The dermatologist explained his thinking. He had never been diagnosed with acromegaly and quickly researched how to do it. The first step was to control the level of one of the growth factors, which is usually induced by this type of brain tumor. If this is high, the patient’s brain needs to be imaged to look for a small tumor in the pituitary gland. It took days for the blood test to come back. It was abnormal. And the CT scan revealed a lima bean-sized growth on his pituitary. Mathis referred the patient to a neurosurgeon who removed the tumor. He did not see the patient again until the following year. By then, the patient reported that his fingers and nose had shrunk, and his gratitude to the young doctor had increased. Mathis was thrilled with his diagnosis. He recently told me, “I’m curious,” and it has been one of his most trusted and valuable tools as a doctor. And he’s not ashamed of having to look at things.

It has been two years since the patient had the surgery, and he and his wife watched with interest the revealing of the man’s old face. The lumpy scalp hasn’t changed, but the wife was particularly happy to get her husband’s old nose back. He’s starting to lose his hair—perhaps he needed excess growth hormone to keep it up—but his wife told me it was a small price to pay.


Lisa Sanders, MD, is a contributing author to the magazine. His most recent book is “Diagnostics: Solving the Most Surprising Medical Mysteries”. If you have a solved case to share, write to her at Lisa.Sandersmd@gmail.com.



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