Prof Annamaria Colao explains the causes and effects of acromegaly and discusses a number of trials comparing the efficacy of current therapies, investigating new first line treatments and treatments for resistant patients. Prof Colao talks about hyperparathyroidism, outlining research into cinacalcet as a way of normalising patient calcium levels and discusses a new register developed in Belgium that allows clinicians treating acromegaly to share data on clinical appearance, resistance profile and patients response.