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A 38-year-old male had 4 years history of type 2 diabetes mellitus with no micro-or macrovascular complications. He was on 1,000 mg of Metformin twice daily. He had excessive sweating and progressive facial changes. Physical examination was notable for enlarged extremities with thick skin, deep nasolabial folds, and coarse facial features (Fig. 1a) . His labs showed A1c of 7.2%, random growth hormone (GH) 11.9 mcg/L and insulin-like growth factor-1 (IGF-1) level 128.2 nmol/L (NR: 12.4-28.3).doi:10.1159/000511693 fatcat:6kyj6ejzp5ewdd5pkbhe3nfqxm