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At that time, she had also undergone uvulectomy because of obstructive sleep apnea that had caused severe snoring. The snoring continued after surgery, albeit much more infrequently. On admission, the patient's blood pressure was 120/80 mm Hg. She had a heart Chloramben rate of 86 per minute, a respiratory rate of 20 per minute, and a body temperature of 36.5��. During physical examination, the facial enlargement with frontal bossing was noticed, as was the disproportionate enlargement of the tongue, nose, lips, hands, and feet (Fig. 1). Hypertrichosis was seen, especially in the lower extremities. Soft tissue swelling was noted, and the skin folds were thickened. Fig. 1 (A) Physical examination of the patient revealed frontal bossing, thickened lips, and an enlarged nose. (B) Exaggerated frontal bossing (arrow) observed from the side. Disproportionately enlarged (acromegalic) hands (C) and feet (D) were also seen. A complete blood count revealed a plasma hemoglobin level of 10.0 g/dL. The serum protein level was 10.5 g/dL (reference range, 6 to 8) and the serum albumin level was 2.5 g/dL (reference range, 3.5 to 5.2), reflecting a reversed albumin/globulin (A/G) ratio. Serum creatinine and calcium levels were 0.63 check details mg/dL (reference range, 0.70 to 1.40) and 8.6 mg/dL (reference range, 8.6 to 10.2), respectively. Thus, the serum calcium level corrected for hypoalbuminemia was 9.2 mg/dL. The fasting plasma glucose level was 109 mg/dL and the 2-hour postprandial plasma glucose level was 280 mg/dL. Hemoglobin A1c was 7.8% and the C-peptide level was 4.8 ng/mL. The thyroid-stimulating hormone level was 1.5 ?U/mL (reference range, 0.4 to 5.0) and the free thyroxine level was 1.3 ng/dL. Basal levels of adrenocorticotropic hormone, prolactin, luteinizing hormone, follicle-stimulating hormone, and estradiol were 23.0 pg/mL, 6.8 ng/mL, 17.1 mIU/mL, 44.4 mIU/mL, and 10.0 pg/mL, respectively, which were all within normal ranges. Serum levels of IGF-1 and human growth hormone (hGH) were elevated to 898 ng/mL (age-adjusted reference range, 71 to selleck compound library 284) and 42 ng/mL (reference range,