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|⊕⊕
)