Why is it missed?The diagnosis of acromegaly is often missed because the condition develops slowly and insidiously, and it often has clinical features which are common in the general population, such as tiredness and musculoskeletal pain. The mean time to diagnosis is eight years, with a range of 6-10 years.5 Studies have reported a high prevalence of certain conditions in patients with acromegaly6(see box), which may confuse the clinical picture as these too are common conditions in general practice.Complications of untreated acromegalyThe following common conditions may warrant checking for acromegaly if other clinical features suggest it, , or may be screened for once acromegaly is diagnosed: Respiratory: sleep apnoea (20-80%, presenting with day time somnolence, and due to anatomical changes affecting craniofacial bones, soft tissues, respiratory mucosa, cartilage and muscles) Cardiovascular: hypertension (40%, pathogenesis unclear but growth hormone causes salt retention), cardiomyopathy, arrhythmias, heart failure Metabolic: diabetes mellitus (19-56%, due to increased insulin resistance), lipid disturbances, hypercalciuria Musculoskeletal: arthropathy (20-50%, due to degenerative osteoarthritis of back and weight-bearing joints), carpal tunnel syndrome (20-52%, due to oedema of the median nerve in the carpel tunnel and soft tissue growth) Other conditions to consider screening for on diagnosis of acromegaly: Gastrointestinal: Colonic polyps, colorectal cancer Possibly increased risk of other malignancies such as lung, thyroid, breast etc