A thirteen year-old boy with progressive enlargement of the joints and distal extremities, clubbing, coarse facial features and hyperhidrosis was investigated. His endocrine profile was normal. Radiological studies demonstrated bilateral symmetrical periosteal new bone formation with acroosteolysis. After extensive investigation to exclude systemic and endocrine causes, a diagnosis of pachydermoperiostosis was made. Awareness of this condition helps to differentiate this syndrome from pulmonary osteoarthropathy and acromegaly.