Traditionally, the assessment of disease activity has always been based on biochemical (i.e., growth hormone—GH and insulin-like growth factor 1—IGF1) and instrumental (e.g., magnetic resonance imaging—MRI) criteria, but over the years, it has become increasingly clear that these tools have multiple limitations in the diagnosis and ongoing clinical care of acromegaly patients. This evidence concerns the gene IGF1 and acromegaly.