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Pseudoacromegaly in pachydermoperiostosis

A 19-year-old male patient presented with a year-long history of progressive painful enlargement of his hands and feet associated with excessive sweating and greasiness of the face, palms and soles. He also noticed pain over his wrists and ankles without any symptoms suggestive of raised intracranial tension and no recent increase in height. Family history was unremarkable. Clinical examination revealed enlargement of hands and feet with digital clubbing and spade-like appearance of the hands (figures 1 and 2). The eyelids were hypertrophied with partial drooping of the upper eyelids. The skin over the patient's face and extremities was coarse, moist and oily, suggestive of excessive sebum secretion. He had no prognathism and no obvious furrowing of skin over face or scalp. Systemic examination was unremarkable.



Figure 1 
Enlarged spade-shaped hands with digital clubbing.





Figure 2 
Enlarged feet with swollen ankles.



Baseline investigations were normal. A detailed hormonal evaluation including the growth hormone (GH) insulin-like growth factor 1 (IGF1) axis, …