You are studying for an upcoming exam, and must pass it to receive credit for the
course.
You are provided with a picture of the scalp of a 37-year-old man who has a 4-year
history of increrasing skin folds on his scalp, excessive sweating, headaches, and
joint pains. Physical examination shows ridges and furrows and thickening of the
skin on his scalp (see picture, below). The digits of his hands and feet are "spaded"
and his jaw is protuberant and exhibits an overbite.
What is your diagnosis, what test(s) would you order to confirm your diagnosis, and
what treatment, if any, do you recomment?
DIAGNOSIS: Cutis verticis gyrata (CVG) in a patient with acromegaly, the latter accounting
for the spading of his hands and feet and the protuberant, overbiting jaw. CVG can
occur as an isolated finding or may be related to a number of conditions including
acromegaly. This patient's insulin growth factor I level was 907 ug per liter (reference
range, 82 to 237) and his growth hormone level was 7.3 ug per liter (reference range,
0 to 0.8). A MRI of the head revealed a pituitary adenoma measuring 27 mm by 25 mm.
The patient underwent a transphenoidal resection of the adenoma plus treatment with
a somatostatin analogue and a growth hormone receptor antagonist for residual tumor.
The CVG persisted unchanged.
Thickening of the scalp with furrows and ridges characteristic of CVG. The scalp
did not change despite treatment of the patient's acromegaly.
.