A 37-year-old man presented to the endocrinology clinic with a 4-year history of excessive sweating, headaches, and joint pain. His wife had also noticed increasing skin folds on his scalp. Physical examination showed thickening of the skin on his scalp with ridges and furrows (Panel A, back of head, and Panel B, top of head). He had enlarged feet and hands and a protruding lower jaw. Findings from laboratory evaluation were notable for an insulin-like growth factor I level of 907 μg per liter (reference range, 82 to 237) and a random measurement of the growth hormone level of 7.3 μg per liter (reference range, 0 to 0.8). A 75-g oral glucose load did not suppress the growth hormone level and confirmed a diagnosis of acromegaly. Magnetic resonance imaging of the head revealed a pituitary adenoma measuring 27 mm by 22 mm by 25 mm. The thickening and furrowing of skin on the scalp, called cutis verticis gyrata, can occur as an isolated finding or may be related to a number of conditions, such as acromegaly, as in this case. The patient underwent transsphenoidal resection of the pituitary adenoma. He had residual tumor and was treated with a somatostatin analogue and a growth hormone receptor antagonist. He received injections of soft-tissue fillers in an attempt to create a smoother appearance of the scalp, but the injections had only partial effect.