IGF1 and hypertrophy: However, the pathogenesis of acromegaly-related cardiomyopathy includes both a direct action of GH and IGF1 excess on the myocardium and indirect mechanisms induced by hormone excess, such as hypertension and derangements in glucose and lipid metabolism; these effects result in cardiac glucotoxicity and lipotoxicity, leading to cardiac remodelling and hypertrophy.