Abstract
<title>Abstract</title> <p>Background Acromegaly is a rare multisystem disorder caused in most cases by a growth hormone–secreting pituitary adenoma. Data from Iraq remain limited, and long-term outcome data from tertiary endocrine practice are scarce. Methods This retrospective electronic database study included 236 patients with biochemically confirmed acromegaly managed at the Faiha Specialized Diabetes, Endocrine and Metabolism Center, Basrah, Iraq, between 5 February 2009 and 17 February 2026. Demographic, clinical, biochemical, radiological, treatment, and outcome data were reviewed. Results The mean age was 42.9 ± 13.4 years, and 53.4% were male. The mean body mass index was 30.3 ± 5.2 kg/m². Hypertension was present in 56.4%, diabetes mellitus in 45.3%, and hyperprolactinaemia in 11.4% of patients. Pituitary magnetic resonance imaging showed macroadenoma in 76.7%, microadenoma in 17.4%, and no visible adenoma in 5.9%. Overall, 136 patients (57.6%) underwent surgery, predominantly by the transsphenoidal approach, and 59 (25.0%) received radiotherapy. Final outcomes were remission in 56 patients (23.7%), active disease in 107 (45.3%), 64 (27.1%) lost to follow-up, and death in 10 (4.2%). In multivariable analysis, any surgery was independently associated with higher odds of remission (adjusted odds ratio 3.52, 95% confidence interval 1.39–8.88; p = 0.008), whereas radiotherapy was independently associated with lower odds of remission (adjusted odds ratio 0.43, 95% confidence interval 0.19–0.98; p = 0.044). Conclusions Acromegaly in Basrah was characterized by diagnosis in middle adulthood, a predominance of macroadenoma, substantial cardiometabolic comorbidity, and incomplete overall disease control. Surgery was the main factor associated with remission, whereas radiotherapy identified patients with more resistant disease. The relatively small number of registered cases over 17 years, despite the large Iraqi population, suggests likely under-diagnosis and delayed diagnosis. Earlier recognition, stronger referral pathways, and improved long-term follow-up are needed to optimize outcomes.</p>