GH1 and neoplasm: Clinical manifestations range broadly and may be related to the adenoma tumor mass itself, such as headache and visual impairment; or may be due to downstream effects of GH and IGF-I excess, for example, acral manifestations, respiratory disorders (such as snoring and sleep apnea), cardiovascular-related diseases, metabolic disorders (such as diabetes), and musculoskeletal disorders including osteoporosis, vertebral fractures and arthropathy (2).