Acromegaly

A key point in this review is that acromegaly may not present the way we were taught:

Patients with longstanding disease commonly present at advanced stages with striking physical characteristics (eg, enlarged hands, feet, lips and tongue; prominent supraorbital ridges; and lower jaw protrusion) (Table 1).11 However, the onset of physical changes is insidious (Figure 3) and patients are unlikely to present with complaints relating directly to these distinguishing signs of acromegaly;5 rather, they are more likely to present with complaints typical of other conditions (eg, cardiovascular disease, diabetes, hypertension, and sleep apnea) more commonly seen in primary care.

You see this type of patient every day.