As the patient was noted on his admission clerking to have coarse facial features with enlarged hands and feet, endocrine evaluation was undertaken; elevated insulin-like growth factor-1, along with a positive oral glucose tolerance test, confirmed the diagnosis of acromegaly. The patient was discharged with anticoagulation and referred to the thrombosis clinic alongside an outpatient MRI of his pituitary, the findings of which were consistent with a pituitary macroadenoma. Here, IGF1 is linked to acromegaly.