An updated clinical practice guideline on acromegaly formulated by an expert task force jointly sponsored by the Endocrine Society and European Society of Endocrinology was recently released. Diagnostic serum IGF-1 assay is recommended in patients with acromegaly features, or with a pituitary mass. Testing random growth hormone (GH) level is not recommended for diagnosis. Oral glucose tolerance test is useful to confirm acromegaly. Surgical resection is recommended for GH-secreting pituitary tumors, with repeat surgery suggested for detectable residual disease. Postoperative evaluation with MR imaging, IGF-1 and GH levels at or after 12 weeks is recommended before starting medical therapy for persistent excess GH. Radiation therapy is suggested for postop patients who do not tolerate or respond to medical therapies. Annual testing is important to detect hypopituitarism or other delayed treatment effects.
Journal of Clinical Endocrinology & Metabolism