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).

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... uitary MRI revealed a 1-cm adenoma. Within 2 months of surgery, he noted significant improvement in his facial appearance (Fig. 1b) . Also, his glycemic control had improved and he was able to stop metformin within 6 months of surgery. Labs showed normal IGF-1 and GH, and his A1c dropped to 6.1%. Repeat pituitary MRI showed complete resection of the pituitary adenoma. At his last visit (4 years after surgery), his IGF-1 remained within normal range, and his HbA1c was 6.2% on diet control alone.