Delayed diagnosis of acromegaly when lower facial features were obscured by masks during the COVID-19 pandemic.

Acromegaly, caused by excessive growth hormone secretion from a pituitary tumor, is associated with characteristic acral changes and multiple comorbidities. Changes in physical appearance, particularly involving the face and extremities, are the most common triggers for the diagnosis of acromegaly. Since the COVID-19 pandemic, widespread mask wearing in medical settings may interfere with the recognition of acromegaly by obscuring key facial features such as the lips and nose. We report the case of a 74-year-old woman referred for poorly controlled diabetes mellitus (DM). She exhibited disproportionate insulin resistance and excessive insulin secretion despite the absence of obesity or visceral fat accumulation. These metabolic abnormalities prompted further physical examination, which revealed characteristic facial changes that had previously been concealed by mask wearing, ultimately leading to the diagnosis of acromegaly. This case highlights that while mask use is essential for infection control, it may inadvertently delay recognition of acromegaly. Clinicians should therefore remain vigilant and carefully evaluate facial features, particularly in patients with conditions commonly associated with acromegaly, such as DM and hypertension. These findings also underscore the importance of careful facial examination in future pandemics or public health emergencies requiring widespread mask use.