Disease activity and treatment responses vary widely according to its structural-functional classification comprising clinical, pathologic, morphologic, and biochemical features, particularly adenoma size and invasiveness on pituitary MRI and GH-granulation pattern.<h4>Objective</h4>To evaluate the association between clinicopathologic acromegaly subtypes and long-term survival.<h4>Methods</h4>This multicenter, bidirectional cohort study assessed all-cause mortality in adults with somatotroph adenomas classified into 3 different subtypes. Here, GH1 is linked to growth hormone secreting pituitary adenoma 1.