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Acromegaly

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Diagnosis Î Following biochemical diagnosis of acromegaly, ES recommends performing an imaging study to visualize tumor size and appearance, as well as parasellar extent. (1|⊕⊕⊕⊕) ES suggests magnetic resonance imaging (MRI) as the imaging modality of choice, followed by computed tomography (CT) scan when MRI is contraindicated or unavailable. (2|⊕⊕ ) Î ES suggests performing formal visual field testing when the tumor is found to abut the optic chiasm on an imaging study. (2|⊕⊕⊕ ) Presentation and Management of Comorbidities and Mortality Risk Î ES suggests evaluating all patients presenting with acromegaly for associated comorbidities, including hypertension, diabetes mellitus, cardiovascular disease, osteoarthritis, and sleep apnea. (2|⊕⊕ ) Î ES also recommends that such comorbidities be longitudinally monitored and rigorously managed. (Ungraded recommendation) Î ES suggests screening for colon neoplasia with colonoscopy at diagnosis. (2|⊕⊕ ) Î ES suggests a thyroid ultrasound if there is palpable thyroid nodularity. (2|⊕⊕ ) Î ES recommends assessing for hypopituitarism and replacing hormone deficits. (1|⊕⊕⊕ ) Treatment Goals of Management Î ES suggests a biochemical target goal of an age-normalized serum IGF-1 value, which signifies control of acromegaly. (2|⊕⊕ ) Î ES suggests using a random GH <1.0 mcg/L as a therapeutic goal, as this correlates with control of acromegaly. (2|⊕ ) Î ES suggests maintaining the same GH and IGF-1 assay in the same patient throughout management. (2|⊕⊕ ) Surgery Indications Î ES recommends transsphenoidal surgery as the primary therapy in most patients. (1|⊕⊕⊕ ) Î ES suggests that repeat surgery be considered in a patient with residual intrasellar disease following initial surgery. (2|⊕⊕ )

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