A 42-year-old woman comes to the primary care clinic because she has been urinating more frequently than she used to and wonders whether she has diabetes. She also feels her muscles have been weakening over the last few weeks. Last week she could not move her right upper limb for an entire day. She had involuntary contraction of muscles with numbness around the mouth. Her temperature is 99 °F (37.2 °C), heart rate is 108 beats/min, blood pressure is 198/105 mm Hg, respirations are 19 breaths/min, and oxygen saturation is 96% on room air. When you question her about her high blood pressure, she reports that she had taken multiple medications to control her high blood pressure but none seemed to help. Review of systems is significant for frequent headaches, polydipsia, polyuria and fatigue. Which of the following is the most likely diagnosis in this patient?
