Acromegaly registries constitute a valuable source of therapeutic outcome information in real-life.To analyze surgical and pharmacological outcomes in the Mexican Acromegaly Registry (MAR).Data was extracted from the MAR informatic platform. Surgical remission was defined by a postoperative post-glucose GH < 1 ng/mL and an IGF-1 < 1.2 x ULN. Pharmacological remission was defined by a basal GH < 1 ng/mL and an IGF-1 < 1.2 x ULN.A total of 650 surgical outcomes were analyzed (94.6% transsphenoidal). Surgical remission was achieved in 40.15%, whereas 44.15% remained biochemically active. Persistently active disease after surgery was significantly associated with harboring an invasive macroadenoma, a basal GH > 10 ng/mL and/or an IGF-1 > 2 x ULN at diagnosis upon bivariate and multivariate analysis. The outcome of monotherapy with first generation somatostatin analogs (SSA) was evaluated in 267 patients (adjunctive in 65%) of whom 28.4% achieved remission. Persistently active disease was significantly associated with harboring an invasive macroadenoma as well as with pre-treatment basal GH and IGF-1 levels of > 10 ng/mL and > 2 x ULN, respectively, upon bivariate and multivariate analysis. Combined therapy with SSA and cabergoline was analyzed in 100 patients of whom 19% achieved remission and 44% remained active; in this subset of patients, only a pretreatment IGF-1 > 2 x ULN was significantly associated with persistent disease activity.Surgical and pharmacological outcomes in acromegaly are highly dependent on tumor size/invasiveness as well as on the degree of hypersomatotropinemia.