Acromegaly presenting as cutis verticis gyrata.

A 17-year-old Saudi male patient presented with progressive asymptomatic skin changes on the scalp for 4 years. Upon examination, he was a well-built muscular male with coarse facial features with broadening of the nasal bridge and thick lips. Scalp examination revealed multiple gyriform oblong skin folds in the fronto-parietal region (Fig. 1). Extensive velvety dark brown plaques were seen on sides of the neck, axillae, and groin. Similar eruption was seen on the knuckles of both hands and around the eyes. Clinical diagnosis of cutis verticis gyrata of the scalp and acanthosis nigricans was made. Because of the extent and the rapid progression of the above changes, acromegaly was suspected. Endocrinology referral confirmed this by the findings of high random growth hormone level at the value of 37.3 mIU/L (normal 0.2-13.0). Arrangement of magnetic resonance imaging (MRI) of the brain was made, but unfortunately the patient was lost to follow-up.