Presentation
Generalized body aches with normal vitals.
Patient Data
AP and lateral skull view reveal increased calvarial thickness, sella turcica enlargement, frontal sinus overgrowth, malocclusion of teeth with prognathism. Calcification of the pinna of the ears is also noticed.
AP and lateral view of bilateral hand and foot show a typical "spade-like appearance" due to prominent subungal tufts. Shafts of metacarpal/tarsal and phalanges appear widened. Metacarpal head appear enlarged and thickened along the margins simulating "beak-like osteophytes"
Frontal and lateral view of spine demonstrate increased disc-facet and intervertebral joint space with relatively mild kyphosis of lumbar vertebrae. Hyperostosis of T11-L3 anterior vertebrae body noted. Lower lumbar vertebrae also reveal posterior scalloping of vertebrae.
Note the heel pad thickness of 29 mm which is significantly greater than the cutoff value of 20 mm in normal person according to age and sex.
Calcification of thyroid cartilage can be seen on the C-spine lateral view, which is a very common finding in acromegalic patients.
Case Discussion
Acromegaly is an endocrinopathy related to excessive growth hormone secretion from a pituitary adenoma in a patient with a fused skeleton. So it may involve other bones, especially of the hands and feet (acral parts) (cf. excessive growth hormone secretion in an unfused skeleton, which causes gigantism).
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