Playing Doctor: Reasoning from Symptoms to Acromegaly

We’ve all heard the expression, “A picture is worth a thousand words.” I once used it as an excuse to get out of drawing a new cover to Beowulf as part of an English assignment. I never felt like my artistic skills were up to snuff, so I wrote a 1,001-word description of the cover as I saw it in my head. My teacher was less than impressed. However, there is certainly value in pictures when it comes to everyday life. Who would buy something on Craigslist or eBay if it didn’t include a picture? How much easier is it to change our hairstyle when we can just show our stylists a picture of the new ‘do?

But pictures can be used in medicine as effectively as they can in buying used stuff or placating our vanities. A picture helped a doctor diagnose a middle aged woman with a rare disease: acromegaly.

In the spirit of appreciating how difficult it is to be a doctor who has to diagnose cases with the rarely seen symptoms that indicate acromegaly (or something else), let’s get the case the way doctors usually do.

The patient was middle aged and overweight. She had high blood pressure, sleep apnea, lower back pain, knee pain, and leg swelling. She had been gaining weight steadily for years despite any and all diet and exercise programs she used.

She, along with the doctors she had already seen, attributed this host of symptoms to getting older, a malady that we all seem to be afflicted by.

Finally, when she produced a photo of herself from a few years earlier. The doctor could not help but notice the profound changes in her facial features. His first thought was thyroid hormone imbalance. He ruled that out because she would have other symptoms.

Next, the doctor asked if she was bruising more easily lately. She had noticed any extra bleeding or bruising. Then he asked if she saw any deep purple or bluish stretch marks on her torso. Again, the answer was no. The doctor had now ruled out Cushing disease.
When he asked about changes in the size of her feet and hands, she announced she had gone up five shoe sizes in recent years. After examining her teeth, or more accurately, the newly formed gaps between her teeth, he confidently said she had acromegaly.

It was the picture that brought about this diagnosis. Her facial features had changed so radically this new doctor knew there must be a problem with her pituitary gland. The average acromegaly patient will go undiagnosed or misdiagnosed for several years. The changes happen so slowly that primary doctors cannot connect the dots.

As a post script to this story, she had a successful surgery to remove the tumor on her pituitary gland. The disease has changed her body permanently, but at least the growth will not continue.

I think we all have a good reason to pose for pictures now. You never know when they might help your doctor diagnose you with a rare disease.

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