GHRL and Insulin resistance: Acromegaly is a relatively uncommon disease, with an estimated prevalence at 1:140,000–250,000.[12] The excess of growth hormone (GH) production could lead to insulin resistance, impaired glucose tolerance, and even diabetes.[12] Ghrelin, another appetite regulatory peptide also had changed levels in acromegaly.[13, 14] The direct relation between growth hormone and the nesfatin-1 has not been studied yet.