Document resource
Background Acromegaly is a rare condition caused by excess production of pituitary growth hormone (GH) with incidence 6-8/million/year(1). Diagnosis is often delayed due to slow progression of physical changes resulting from excess insulin like growth factor (IGF-1), by 5-10 years(2). Headaches are usually due to space occupying adenomas; we present a case caused by alternative craniofacial manifestations: sinus soft tissue enlargement.Case A 57-year-old man presented to neurology clinic with 3-month history of headache over the frontal region radiating to the maxilla and temples, lasting 30 minutes in the morning, with no associated sensory sensitivity, visual obscurations, jaw claudication or cranial autonomic symptoms other than a “stuffy nose” for several months. Examination showed prominent supraorbital ridges, hearing loss, normal optic discs and visual fields, neurological examination was otherwise normal. BP on ramipril 157/89. ESR&CRP normal, IGF-1 40(9-31.7), GH 2.56(0-2.8), not suppressed by oral glucose tolerance testing. MRI revealed sinus soft tissue enlargement & pituitary studies demonstrated a right sided focal subtle bulge.Discussion Soft tissue enlargement and sinus soft tissue enlargement are recognised in acromegaly, and high incidence of mucosal hypertrophy and polyposis have been described(3). Clinical examination is vital in the recognition of treatable unusual causes of headache.carolynnedoherty@doctors.org.uk