Acromegaly as a clinical entity has been recognized since ancient times, it is considered a disease of low incidence but with great impact in terms of morbidity, mortality and associated diseases. Today its diagnosis remains a challenge because pathognomonic symptoms and signs are of slow onset and subtle, so it requires a high index of suspicion and clinical expertise from the health personnel who faces the patient with acromegaly, particularly at an early stage of the disease. This article will go through the steps to establish the diagnosis of acromegaly in a suspect patient, with special emphasis on the required hormonal measurements.