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Abstract

A 32-year-old man sought medical attention because of a 13-year history of enlargement of his hands and a 15-year history of enlargement of his feet. These features were associated with numbness of the fingers and had resulted in injury to them. Ten years before the current presentation, the patient had noted progressive coarsening of his facial features; in addition, for 1 year he had had difficulty seeing because of excessive ptosis. Physical examination revealed excessive wrinkling and thickening of the face and scalp, with exaggerated furrowing of the facial lines. Redundant upper eyelids and severe ptosis were evident. The hands and feet were large and nontender, and digital clubbing was noted. Pain sensation was decreased on the extremities. The visual fields and papillary and ocular movements were normal. Pertinent laboratory studies revealed the following: fasting blood glucose, 75 mg/dL; fasting growth hormone, less than 1 ng/mL; 1-hour postchallenge glucose, 92 mg/dL; and 1-hour postchallenge growth hormone, less than 1 ng/mL. Radiographic studies of the hands (Fig. 1) and of the long bones of the leg (Fig. 2) were performed. What is the diagnosis? Fig. 2 View Large Image Figure Viewer