A woman with enlarged hands and feet

A woman in her 40s reported a two month history of her shoes and gloves becoming increasingly tight, headaches, blurred vision, and a tight sensation in her skin. She did not report any joint pain or limb numbness. She had experienced amenorrhoea for one year, which was treated with traditional Chinese medicine without improvement. She also had a one year history of hypertension, which was well controlled with amlodipine.

On examination, her height was 145 cm, weight was 60 kg, and her body mass index (BMI) was 28.5. She had rough skin, an enlarged nose and tongue, thickened lips, and macrodactyly of the hands (fig 1) and feet. Her voice was deeper than it had been. Visual field testing indicated bitemporal hemianopia. Table 1 summarises the laboratory test results.