Background and objectives:Acromegaly is a rare hormonal disorder; the prevalence is around 60 cases/ million population, incidence is3.3new cases/million/year. Mortality rate 2 to 4 times that of general population. It is usually the result of a somatotrope adenoma in more than 95% of cases.The aim is to study our patient`s characteristics, to identify the best management for acromegaly, which can induce clinical, and biochemical remission, also this paper aimed to increase acromegaly awareness regarding the importance of early diagnosis of this disease. Methods:This is prospectivecohort study involving 15patients; the duration of study is 2 years (June 2015-June 2017). All patients diagnosed by high level of insulin-like growth factor 1 followed by growth hormone suppression test and MRI of pituitary gland. Those patients underwent transsphenoidal resection, diagnosis confirmed by histopathology too. Results:The median age of patients at presentation was 47.3 (SD 9.9), with majority between 40-50 years. Females constitute 8 of the patients, while number of males was 7. The most common chief complaint was headache accounting for 40% of cases. All patients at presentation were suffering from macroadenoma.The combination of surgical and medical treatment was more successful in reducing GH and IGF1 levels in comparison to medical treatment alone (p value of <0.001 and 0.037 respectively). Conclusions:The combination of surgical and medical treatment was superior to medical treatment alone in reducing GH , IGF1 level and inducing tumor remission.The two dilemmas we are facing here in Duhok are: First; delayed diagnosis as reflected by the fact all of our patients were macroadenoma at presentation, that is why we need to increase awareness about this disease and the importance of early diagnosis and early referral before onset of complications which directly associated with increase mortality. Secondly; low compliance for medical treatment, to improve this we need to provide free measurements of both GH and IGF1 levels for all patients receiving somatostatin analogue treatment