So you’ve fully unlocked the altar, completed the season journey as Guardian. What is there left to do?
One could do the other 2 conquests (or 7 if one is into masochistic game play 
[I’m kidding, if you enjoy HC that’s entirely fine by me]).
If a Visions portal popps open, one can sleepwalk thru that. But that won’t take too long.
If more Petrified Screams drop, Echoing Nightmares are there. But that is done in a few minutes.
Puzzle Rings and Bovine Bardiche can offer a quick change in play.
But besides that, is there anything else to do besides going for even higher GR? Or is that the only “real” end game?
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You just answered your own question.
Campaign Mode is THE GAME.
Adventure Mode, which includes Season and non-Season is THE END GAME content.
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There’s also about a bagrillion achievements to work on if you just want a change of pace and/or do it all again on HC.
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The real end game is what you make it. If GR150 is your goal go for it. Every season I do the seasonal achievements to rank on the Achieve LB. Sometimes, I make up my own unique challenge for the season.
If you go for full completion on the Achievements, you need to do 20 conquests. The 5 unique ones on SC, HC, SSF SC, and SSF HC.
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Aside from Greater Rifts, all other activities are limited due how vast your power is, and how can it scale over those. You can farm Whispers from Echoing Nightmares so you can augment the non-Season characters when you replace their items with better ones; but this again tied to Greater Rifts.
Secret levels from Puzzle Rings and Bovine Bardiches are not as interesting or offer abundant loot quantity unless you chipped an Ancient Puzzle Ring. I think in this Season 34, you can Sanctify Puzzle Rings to open Ancient Vaults but I have never tried. I always salvage mine, because you have a chance to get more FS from salvaging Sanctified items than a single run of Ancient Vault.
Even then Vault runs don’t hold a light to a high floor Visions of Enmity; where you only want Bovine Bardiche just so you can fulminate them. Before Altar get introduced Bovine Bardiche used to have some weight, but now not so much.
Somewhat yes, you either push Greater Rifts or chase Visions. Anything other than that are limited compared to them in one way or another. I guess Nephalem Rifts and Echoing Nightmares are good for some Blood Shards and Greater Rift keys but you can achieve latter in plenty from Visions, again.
You can chase completion at Set Dungeons, other Conquests or missed achievements at Campaign, but you can not shake the feeling of that you could farm Visions or Greater Rifts and grow in power instead. You have options but only one of them stretch on and on to scale with your power level properly.
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Yes if your goal is get higher paragon level or clear the highest GR you can before the season ends.
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In terms of more difficult content, yes, GR is really the only place more difficult than T16. So many (like me), make getting stronger and pushing GR their goal every season. That’s what I enjoy.
But people play this game in different way, some chase achievements, some grind for rare cosmetics, some want to try a lot of different builds and classes, some collect primals, etc etc.
If you go down the path of pushing GRs, then completing guardian, the altar and setting up a build that can speed through T16 and GR90 is just warmup, the real game starts after that.
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I’m trying to get a GR150 clear with every class.
Currently at 5/7. SSF.
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Thanks all!
I did - works. 
that’s what I should do then.
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If you’re pushing the leaderboards, in some seasons you need paragon for that, so that means many many speed Grifts of 120 to 130. There used to be argument about raising Torment Levels because T16 doesn’t offer enough XP. But these were the same people who championed Speed Grifting to gain XP.
Personally, I find Speed GRifting as boring as running T16 but it’s a necessary evil. Some seasons, like this one, there’s a build or two that can run GR120 to 125 in under 2 minutes and you can challenge yourself to get your time to as close to a minute as possible in good GRifts. But really, that’s just a band-aid.
But yes, the Leaderboards are the end game. Rank 1 is reserved for botters or really good players but ranking in the Top 10 is possible on some leaderboards without botting and on a casual basis.
In the Soul Stone Season, I ranked in the Top 10 with some 2000 paragon with Natalya’s and challenged myself to my time under 8 minutes. Got there about halfway through the season and quit and when the season ended I had only fallen to Rank 12.
Anyway, this one of the good seasons where all classes have a chance as GR 150. Just some need more paragon than others.
Edit:
But for new players or the inexperienced, it’s good to set a reasonable goal for yourself, like ranking in the Top 100-200 depending on the Leaderboard or just hitting GR 150 with an ultra-powerful build like the Bells Monk this season.
As you improve a player, you can raise your goals like going for the Top 50 on one of the more obscure Leaderboards like one for an unpopular set or class.
Lots of casual players just set the goal of completing a GR 150 with a powerful build like Meteor Wizard in the Ethereal Season, Bell Monk this Season, or like I did, Nat’s in the Soul Stone Season. (The Soul Stones are really overpowered, and tons of builds can do a GR 150 with that Theme and the Altar.)
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Great you killed Diablo. Endgame achieved.
Now Achieve Glory, Achievement points = 8370 !
Successfully complete a Greater Rift 150 solo, in time.
Reach level 5,000.
And get all items and item transmorgs too.
You shouldn’t. You have a 1/5 chance to get 15 FS from salvaging a sanctified item, which leaves a 4/5 chance of getting 0 FS. That’s an average of 3 FS per salvaged sanctified item. You’ll average at least a dozen FS per (sanctified) ancient vault run from salvaging the items that drop. Plus a bunch of gold and gems, and a decent chance of another crucible. You should sanctify every puzzle ring you find that isn’t already ancient.
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Coming across single goblin floor on Visions could offer more loot, materials and gold than running two maybe three Ancient Vaults, back to back. Consuming Sanctified Puzzle Ring can help to a degree but doesn’t worth slowing your speed farm runs.
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That’s the key word there. “Could.”
I “could” run a GR90 and get 12 primals. I “could” also win the lottery and never have to work again.
Visions are never a guaranteed thing, gobbo floors within them even less so. But you know what has several gobbos? Guaranteed? Ancient. Vaults. A bird in hand…
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Compared to a Vault at T16, even without a goblin floor, you would get plenty of loot from a single Vision and experience gain as each floor grows in difficulty. You don’t need to wait 60 seconds between Visions either. Their intervals vary, but loot is always guaranteed and much more abundant than running multiple Vaults which merely offer 15-20 Legendary items and a handful of materials if you are any lucky.
If you stick to bird in hand, it’s your choice, but you could have run a Greater Rift at tier 90 or tier 100 and get better loot on top of way more experience.
I believe pseudo random number generators would be programmed to prevent such case. I’m talking about numbers, not stretches. Vault runs can be fun to gear up your alts, get gold for empowered GRs, power level a friend or safe bet in Hardcore rather than Visions but they’re not entirely top notch, nor efficient.
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Ancient vaults are great for normal gems, but can’t compete with visions or GRs when it comes to drops/mats/XP per hour, even if you have the rings. So once you have enough normal gems, it’s not optimal to run them any more.
There is a place for sanctified puzzle runs early game if you’ve been lucky and got a few good ancients and screams (or you scream-share in a group), but don’t have the normal gems to keep up. Then a sanctified puzzle ring or two is the answer.
Maybe very early it’d make sense to run one to level your equipped gems, and get dbs? Assuming you found enough puzzles to feed the altar and have leftovers…
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Do more conquests… for kicks, push the ladder, shoot for better versions of your gear.
Not a lot of choices, but for some, that’s plenty as some do not like vast variety.
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