Pegvisomant is a new drug that blocks growth hormone peripheralreceptors, allowing normalization of insulin-like growth factor-1levels and consequently of clinical symptoms, reducing morbidityand mortality associated with acromegaly in almost all patients.Its introduction made us review the literature aiming to comparethe currently available therapies for acromegaly and theirrespective advantages and disadvantages. The treatmentalgorithms for this disease were reviewed considering that thedifferent existing therapies allow more adequate individualizationto each specific case, and addressing cost, availability, efficacyand safety.