Endocrine Society GUIDELINES Bundle (free trial)

Acromegaly

Endocrine Society GUIDELINES Apps brought to you free of charge courtesy of Guideline Central. All of these titles are available for purchase on our website, GuidelineCentral.com. Enjoy!

Issue link: http://eguideline.guidelinecentral.com/i/1140190

Contents of this Issue

Navigation

Page 1 of 7

Key Points Î Acromegaly is a chronic disorder caused by growth hormone (GH) hypersecretion. Î Over 95% of patients with acromegaly harbor a GH-secreting pituitary adenoma arising from somatotroph cells. Î In less than 5% of cases, excess growth hormone-releasing hormone (GHRH) secretion from a hypothalamic tumor or a neuroendocrine tumor (usually from lung or pancreas origin) may lead to somatotroph hyperplasia and acromegaly. Î More rarely, ectopic GH production by an abdominal or hematopoietic tumor may cause acromegaly. Î Hereditary conditions include multiple endocrine neoplasia-1 (MEN1), Carney complex, and McCune-Albright syndrome. Germline aryl hydrocarbon receptor interacting protein (AIP) mutations have been described in familial acromegaly with more aggressive tumors. Î Hypersecretion of GH leads to excess production of insulin-like growth factor-1 (IGF-1), leading to a multisystem disease characterized by somatic overgrowth, multiple comorbidities, premature mortality, and physical disfigurement. Î A multidisciplinary approach is critical for the management of acromegaly. Diagnosis Î The Endocrine Society (ES) recommends measurement of IGF-1 levels in patients with typical clinical manifestations of acromegaly, especially those with acral and facial features. (1|⊕⊕⊕ ) Î ES suggests the measurement of IGF-1 in patients without the typical manifestations of acromegaly, but who have several of these associated conditions: sleep apnea syndrome, type 2 diabetes mellitus, debilitating arthritis, carpal tunnel syndrome, hyperhidrosis, and hypertension. (2|⊕⊕ ) Î ES recommends measuring serum IGF-1 to rule out acromegaly in a patient with a pituitary mass. (1|⊕⊕⊕ ) Î ES recommends against relying on the use of random GH levels to diagnose acromegaly. (1|⊕⊕⊕ ) Î In patients with elevated or equivocal serum IGF-1 levels, ES recommends confirmation of the diagnosis by finding lack of suppression of GH to <1 mcg/L following documented hyperglycemia during an oral glucose load. (1|⊕⊕⊕ )

Articles in this issue

Archives of this issue

view archives of Endocrine Society GUIDELINES Bundle (free trial) - Acromegaly