Clinical manifestations of acromegaly include: Choose all that applies: (Select All that Apply.)

A. Development of skin tags is a common manifestation due to hormonal changes associated with acromegaly. B. A softening voice can occur due to enlargement of the vocal cords and surrounding tissues. C. Weakness in voluntary muscles may result from hormonal effects on muscle tissue over time. D. Involution typically refers to the reduction in size or activity of an organ or tissue, which is not characteristic of acromegaly. E. Altered vital signs may occur, but are not specific or unique clinical manifestations of acromegaly. F. Soft tissue swelling is a prominent feature due to excess growth hormone leading to tissue enlargement.