Biochemical evaluation for growth hormone excess at this time revealed an IGF-1 level of 535 ng/mL by LC/MS (reference range 50–317 ng/mL, Z-score > 3) and morning fasting growth hormone level of 1.57 ng/mL (reference range 0.01–3.61 ng/mL). The gene discussed is IGF1; the disease is acromegaly.