Woman with deepening voice and headaches

A 30-year old woman complained of headaches, disturbances of vision, deepening of the voice and generalized weakness. She had amenorrhea for the past year. Although her family had not noticed it, she believed her facial features had changed - becoming somewhat coarse with thickening of the facial folds and furrowing of the brow. Upon questioning, she stated that she recently required a larger shoe size.

Laboratory studies revealed hypercalcemia and impaired glucose tolerance. Plasma growth hormone levels were also elevated.

The correct answer is B. Acromegaly. There were a total of 12 responses. A breakdown of responses are inside the parentheses below.

The most likely diagnosis is:

A. Gigantism (1)
B. Acromegaly (10)
C. Cushing syndrome (0)
D. Graves disease (0)
E. Hypothyroidism (1)

(see results graphically)