Image of the Week: When a tight wedding ring suggests a rare diagnosis

A 42-year-old man presents with a long history of headaches, impaired vision, and fatigue. He mentions his wedding ring no longer fits and he has joint pain. Swollen hands and feet, coarse facial features, and a bitemporal hemianopsia are noted on examination. Investigations reveal a diagnosis of acromegaly secondary to a pituitary macroadenoma and he is referred for surgery. Its location means the tumor cannot be fully resected, but it is debulked. His IGF-1 concentrations remain elevated following surgery. What is the most appropriate next step in managing this patient? Take the quiz, learn more about this case, and join the conversation on Figure 1.

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