A 37-year-old man presented to an endocrinology clinic with a 4-year history of excessive sweating, headache, and joint pain. His wife added that she had noticed increasing skin folds on the scalp of her husband. Physical examination Physical examination revealed thickened skin with increased ridges and furrows on the scalp. The patient’s feet and hands were found to be enlarged, and the lower jaw was protruding. Laboratory investigation Laboratory tests were remarkable for elevated levels of insulin-like growth factor I (907 µg/L; reference range: 82 to 237 µg/L) and growth hormone (7.3 µg/L; reference range: 0-0.8 µg/L).
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