This case of a pituitary macroadenoma with treatment-resistant acromegaly and hyperprolactinemia successfully managed with the introduction of pasireotide suggests that LAR pasireotide may have considerable utility in such patients where IGF-1 levels do not respond to standard treatment regimens, such as octreotide and/or cabergoline. The gene discussed is IGF1; the disease is hyperprolactinemia.