A 34-year-old man who had been admitted to the hospital with diabetic ketoacidosis was noted to have coarse facial features. He had no known medical history but had noted an increase in shoe size by three full sizes over the past 10 years and blurry vision for the past 3 years. Physical examination showed a widened nose, frontal bossing, prominent lower jaw, and malocclusion of the upper incisors (Panel A), findings not seen in a photograph taken 15 years earlier (Panel B). Visual-field testing showed bitemporal hemianopsia. Laboratory studies showed a glycated hemoglobin level of 12.3% (reference range, 5 to 14), an insulin-like growth factor 1 (IGF-1) level of 478 ng per milliliter (reference range, 53 to 331), and a growth hormone level of more than 65 ng per milliliter (reference value, ≤7.1).

Presentation A 50-year-old woman with a long history of cigarette smoking asked her dentist about a white oral plaque that she noticed on the underside of her tongue. She thought it had been there for several months. It was not painful and didn’t seem to cause any other symptoms, but she was concerned it might be a problem. She was otherwise in good health. Can you diagnose the patient? A. Oral Lichen planus B. Leukoplakia C. Oral candidiasis D. Oral frictional keratoses

A 50-year-old woman with a long history of cigarette smoking asked her dentist about a white oral plaque that she noticed on the underside of her tongue. She thought it had been there for several months. It was not painful and didn’t seem to cause any other symptoms, but she was concerned it might be a problem. She was otherwise in good health. Can you diagnose the patient? A. Oral Lichen planus B. Leukoplakia C. Oral candidiasis D. Oral frictional keratoses