Acromegaly: Diagnostic Challenges and Individualized Management
Maria -- Fleseriu, MD
Oregon Health &Science University
Acromegaly is an insidious disease with multiple comorbidities impacting physical function, longevity, and quality of life, if unrecognized or left untreated. Diagnosis may be difficult in “non-classical” cases and further complicated by variability of IGF-1 and GH assays among laboratories and variety of individual factors affecting measurements. New experts’ consensus suggests that IGF-1 level 1.3 times upper limit of normal in conjunction with classical symptoms and signs confirms the diagnosis. Pituitary surgery remains the first-line treatment. Persistent disease is usually treated medically; selection of therapy depends on tumor characteristics, individual risk factors for resistance to treatment and metabolic profile of the patient. Radiation is reserved for aggressive adenomas not responding to medication and surgery. Timely screening and treatment of comorbidities is essential. Periodic evaluation of treatment effectiveness, side effects and quality of life helps improve care and patient satisfaction.