The peak occurrence of acromegaly is at age 40-45. In children, GH hypersecretion prior to long bone epiphyseal closure results in gigantism. The presentation of acromegaly in adults is usually indolent, and diagnosis is typically delayed by up to a decade. Pts may note a change in facial features, widened teeth spacing, deepening of the voice, snoring, increased shoe or glove size, ring tightening, hyperhidrosis, oily skin, arthropathy, and carpal tunnel syndrome. Frontal bossing, mandibular enlargement with prognathism, macroglossia, an enlarged thyroid, skin tags, thick heel pads, and hypertension may be present on examination. Associated conditions include cardiomyopathy, left ventricular hypertrophy, diastolic dysfunction, sleep apnea, glucose intolerance, diabetes mellitus, colon polyps, and colonic malignancy. Overall mortality is increased approximately threefold.