<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 40-year-old woman visits her physicians office with her husband. Her husband says that she has been complaining of recurring headaches over the past few months. A year ago she was diagnosed with diabetes and is currently on treatment for it. About 6 months ago, she was diagnosed with high blood pressure and is also taking medication for it. Her husband is concerned about the short span during which she has been getting all these symptoms. He also says that she occasionally complains of changes and blurring in her vision. In addition to all these complaints, he has observed changes in her appearance, more prominently her face. Her forehead and chin seem to be protruding more than usual. Suspecting a hormonal imbalance, which of the following initial tests would the physician order to indicate a possible diagnosis?? A: Pituitary magnetic resonance image MRI, B: Serum insulin-like growth factor-1 IGF-1, C: Serum growth hormone, D: Glucose suppression test, E: Chest X-ray,  <response>: This is a clinical case scenario describing a 40-year-old woman with recurring headaches, diabetes, high blood pressure, vision changes, and facial changes including protrusion of the forehead and chin. The question asks which initial test the physician should order to indicate a possible diagnosis of hormonal imbalance. Based on the symptoms described, the facial changes and vision changes suggest a possible diagnosis of acromegaly, which is caused by excess growth hormone production, usually from a pituitary tumor. Headaches and high blood pressure can also occur with acromegaly. The initial diagnostic test for acromegaly would be measurement of IGF-1 levels, which are elevated due to excess growth hormone. MRI of the pituitary would confirm the presence of a tumor but is not the initial screening test. The other tests listed do not screen for acromegaly specifically.B: Serum insulin-like growth factor-1 IGF-1 