Case of a woman whose shoe size increased from 5 to 7 over two years
1. It was an usual OPD, when I was counselling one of my patients with back pain about exercise, diet and correct posture. Incidentally, I noticed his wife's face who was sitting beside the patient.
#MedTwitter
1. It was an usual OPD, when I was counselling one of my patients with back pain about exercise, diet and correct posture. Incidentally, I noticed his wife's face who was sitting beside the patient.
#MedTwitter
2. Her nose & lips appeared a bit larger than usual. When she smiled, her teeth were little spaced out and tongue was also little larger than normal. She spoke with a little heavy voice.
Being a #neurologist, I was imagining the possibility of a brain #disease.
#neurotwitter
Being a #neurologist, I was imagining the possibility of a brain #disease.
#neurotwitter
3. I asked her- "Don't mistake me, but has your shoe size increased?" Her eyes almost popped out. She replied with a shocked expression- "doc, yes! It has increased from 5 to 7 in the past two years. Don't everyone's feet become larger as they grow older?"
She was 37-year-old now
She was 37-year-old now
4. I responded- "Feet do grow in childhood and adolescence but at your age- I am afraid, they don't grow."
By now, I was almost certain about the disease I was suspecting and asked her to do a blood test and come back for review.
I was more concerned about her, than her husband.
By now, I was almost certain about the disease I was suspecting and asked her to do a blood test and come back for review.
I was more concerned about her, than her husband.
5. Blood test- Insulin like growth factor 1 (IGF 1) was very high, suggestive of excess growth hormone (GH) secretion.
Since GH is secreted from #pituitary gland in brain, I asked for MRI Brain, which confirmed the diagnosis of pituitary adenoma (a benign tumor).
#Endotwitter
Since GH is secreted from #pituitary gland in brain, I asked for MRI Brain, which confirmed the diagnosis of pituitary adenoma (a benign tumor).
#Endotwitter
6. A final diagnosis of acromegaly due to excess GH secretion from pituitary adenoma was made. Endocrinology and neurosurgery opinions were taken. She was operated soon and the tumor was removed through the nose route, without opening the brain.
7. She made excellent recovery. Facial features, tongue & speech improved.
IGF 1 level normalized after 12 weeks.
She required medications for mild diabetes.
She possibly had the disease for two years before it was diagnosed. She was lucky to escape from serious complications.
IGF 1 level normalized after 12 weeks.
She required medications for mild diabetes.
She possibly had the disease for two years before it was diagnosed. She was lucky to escape from serious complications.
8. Take home message
*Increase in shoe size (due to feet becoming larger) and changes in facial appearance in adults could be features of acromegaly (GH excess).
*Initial diagnosis can be made by a simple blood test- IGF 1
*Early treatment can prevent serious complications.
*Increase in shoe size (due to feet becoming larger) and changes in facial appearance in adults could be features of acromegaly (GH excess).
*Initial diagnosis can be made by a simple blood test- IGF 1
*Early treatment can prevent serious complications.
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