A 30-year-old male presented with headache and acral enlargement (figure 1).On examination, he had bitemporal hemianopia, acanthosis nigricans, skin tags and cutis verticis gyrata (CVG) from which he was asymptomatic (figure 2). On investigation, serum growth hormone (GH) after 75 g glucose load was 26.8 ng/ml (N, <1 ng/ml) with insulin-like growth factor 1 (IGF-1) of 1126 ng/ml (N, 117–329 ng/ml). MRI …