At the 4th International Workshop on Highlights in Basic and Clinical Neuroendocrinology, held in Athens in November 2005, internationally recognized experts presented a series of lectures covering current knowledge in the treatment modalities for acromegaly and providing useful updates in basic research related to growth hormone and growth factors. The special issue starts with an historical annotation of acromegaly over the last 120 years. The reader can find up-to-date information regarding the use of somatostatin analogs in relation to somatostatin receptors for the treatment of acromegaly, the GH receptor antagonists and the role of IGF binding proteins. The diagnostic utility of PET imaging and dynamic tests for defining active acromegaly are reviewed. In addition, there are papers presenting the pathology of acromegaly and predictive markers of pituitary adenoma behavior, the molecular genetics in Carney Complex and genetic aspects, the regulation of the human GH gene family, and data of GH-secreting tumors from animal models. Regarding Neurosurgery, transsphenoidal microsurgery for newly diagnosed acromegaly and the endoscopic versus the traditional approach in pituitary surgery are presented. There is also additional information on acromegaly in relation to cancer, cardiovascular system and the questionable role of radiotherapy. Lastly, the quality of life and the cost of medical care for the acromegalic patient are discussed. This issue is useful for clinical endocrinologists, neurosurgeons, radiologist, pathologists and basic scientists.