Letters to the editor

A woman in her 50s presented to her general dental practitioner complaining of movement of her lower teeth that had changed the way in which her upper and lower teeth met. She had also noticed an enlarged tongue and lower lip (Figure 1). Apart from the oral changes, she also presented with an increased shoe and finger size. The GDP had referred the patient to the oral and maxillofacial team at Hillingdon Hospital. The patient was seen by the oral and maxillofacial consultant who, following a detailed history, advised specific blood tests and an MRI scan to assist with the diagnosis. The patient's past medical history included sleep apnoea for which she used a CPAP machine, and hypertension for which she took amlodipine. Her investigation results confirmed a diagnosis of acromegaly with elevated growth hormone (19.8 µg/L) and IGF-1 (56.9 nmol/L) levels. Her Hb1Ac level was 36 mmol/mol. The remainder of her blood tests, including calcium, thyroid and liver function tests, were normal.