An excess of growth hormone (GH) from a pituitary adenoma can result in gigantism and acromegaly; neurosurgical intervention is often required. This chapter presents a case study of a 36-year-old female weighed 115 kg and was 218.5 cm tall. She was scheduled for a transsphenoidal resection of the pituitary adenoma that had caused her gigantism. From the viewpoint of airway management in the acromegalic patient, several concerns exist: the tongue may be enlarged; redundant folds of tissue may be present in the oropharynx; the epiglottis is often enlarged; and laryngeal stenosis occurs more frequently compared with the general population. In the case of gigantism, several additional potential problems should also be considered: possible need for an extra long operating table; possible need for an extra large laryngoscope; endotracheal tubes may need to be placed deeper than usual; and an extra large face mask may be needed as in our case.