Acromegaly, a neuroendocrine disorder due to excess growth hormone and insulin like growth factor-1, has large spectrum of underlying comorbidities. Hereby we report acromegalic cardiomyopathy in 65 year old male patient who also had acromegalic changes involving various other systems and anesthetic management of the same when he was scheduled for definitive transnasal trans-sphenoidal resection of pituitary adenoma.