Around 70% of somatotroph adenomas are diagnosed as macroadenomas, which decreases the chance of obtaining a surgical cure [42]. In centers with vast experience in transsphenoidal resection of pituitary adenomas, the cure rates are >80% for microadenomas and 43,44,45], with an overall long-term cure of around 60% [46]. Furthermore, the cure rate after stereotactic radiosurgery is around 50% at 7 years [46,47]. The definition of disease control, according to the guidelines elaborated in 2014, co-sponsored by the European Society of Endocrinology, is represented by normal serum IGF-1 for sex and age and random GH 16,17]. Disease control is obtained in 20–60% of patients with the use of first-generation SRL [48]. Pasireotide, a second-generation SRL, has shown to be superior to Octreotide in achieving biochemical disease control [49]. The efficiency of Pegvisomant was around 60–70% in “Acrostudy” [50] but much greater in studies that used higher doses, normal IGF-1 being obtained in 90–97% of patients [51,52]. Alternative treatments include combination therapy between SRL, Pegvisomant or Cabergoline (dopamine agonist) [53]. Taking all of this into account, we have to consider the effect disease activity has on the prevalence and incidence of VFs. Three of the studies only analyzed patients with controlled disease [20,26,28], another three only enrolled patients with active disease [33,38,39] and among the others, the frequency of uncontrolled/active disease varied between 29.8% and 77.1%. Six of the studies analyzed the association between disease activity and the prevalence or incidence of VFs. Bonadonna et al. [18] and Uygur et al. [29] observed the association between VF prevalence and active disease, the first found an association between the two but the second did not. Pelsma et al. [20] found an association between active disease duration and VF prevalence, but not with VF progression. Incident VFs were associated with both active disease and active disease duration in the research of Mazziotti et al. [37]. Chiloiro at al found an association between incident VFs and persistence of active acromegaly at follow-up [38], and in another study, they also found an association with active disease duration [39]. Regarding the prevalence of VFs in patients with controlled disease, in the three studies that only analyzed patients with controlled disease, it ranged from 11.53% in the study of Calatayud et al. [29] to 59% in that of Wassenaar et al. [27] and 87.1% in that of Pelsma et al. [21]. The latter also found an incidence of 35.5% of VFs during a follow-up period of 9.1 years [21]. Bonadonna et al. found a similar prevalence in patients with controlled disease as in the control postmenopausal group, of 33.3% [19]. Uygur et al. reported a prevalence of 22.2%, similar to that of patients with active disease, and Mazziotti et al., in the prospective study from 2020, documented an incidence of 18.24% during their follow-up period of four years, compared to 36.03% in patients with active disease [38]. Interestingly, in their 36-month follow-up, Chiloiro et al. [39] observed significantly fewer incident VFs in patients treated with Pasireotide compared to Pegvisomant, with both active and controlled disease at the end of the study. All available details are presented in Table 2.