As emphasized by some authors, acromegaly is not always accompanied by a typical phenotype: “acromegaly is a clinical syndrome that may not manifest with clear diagnostic features” (1), “some patients with acromegaly have mild or absent clinical features” (2), “the diagnosis does not require the presence of typical phenotypic features” (3), and “we suggest the measurement of IGF-1 in patients without the typical manifestations of acromegaly, but who have several associated conditions” (4). The gene discussed is IGF1; the disease is acromegaly.