Acromegaly can cause substantial morbidity and is associated with increased mortality. Control of growth hormone and insulin-like growth factor-1 secretion can reduce morbidity and normalize life expectancy. However, biochemical control can be difficult condition to attain in a substantial proportion of patients. Recently two new therapeutic options, pasireotide long-acting release (LAR) and pegvisomant, have become available for use in Australia. This presentation will compare the efficacy and safety of these new medications to other therapeutic options and attempt to integrate them into an acromegaly treatment algorithm.