OBJECTIVES: To estimate the healthcare resource utilization and costs associated with the management of patients with acromegaly in Québec. METHODS: A retrospective cohort study was conducted using data from the Quebec public health plan (RAMQ) for the period from January 2001 to June 2011. Patients with at least two diagnosis of acromegaly (ICD9=2530) reported by an endocrinologist or an internist were selected. Characteristics of the study population are described in terms of age, gender and co-morbidities. Healthcare resources utilization was estimated, in terms of medical/surgical services, hospitalization, emergency visits and medications. Costs of these resources were estimated annually over a three-year period from the time of diagnosis of acromegaly and from the time of specific intervention (transsphenoidal surgery (TSS) or medical treatment). RESULTS: A total of 655 patients had at least diagnosis of acromegaly on two occasions reported by an endocrinologist or an internist. Average age was 49.0(SD=19.1) and 55.4% were females. A pituitary adenoma was reported in 27.0% of patients. During the study period, TSS was performed for 20.3% of patients while 19,7% had a medical treatment. Medical therapy included bromocriptine (9.2%), cabergoline (7.6%), octreotide (7.2%), lanreotide (0.5%) and pegvisomant (0.3%).  Annual costs for all patients were $7,203(SD=$12,706), $5,038(SD=9,545) and $5,266(SD=12,291) respectively for each of the three year following initial acromegaly diagnosis. For patients who had a TSS or a medical treatment, or a combination of these, total cost in the first year following the initial intervention varies from $9,925 to $17,813. The most frequent comorbidities were diabetes (47.6%) and hypertension (42.7%).  Sleep apnea and carpal tunnel syndrome were reported in 11.1% and 5.3% of patients respectively Average annual costs of medications for the treatment of comorbidities were  $1,454(SD=3,338). CONCLUSIONS: Results of this analysis of the RAMQ database illustrate the significant economic burden of acromegaly and of its comorbidities.