Key Points

Diagnosis

• 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|⊕⊕⊕o)
• 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|⊕⊕oo)
• ES recommends measuring serum IGF-1 to rule out acromegaly in a patient with a pituitary mass. (1|⊕⊕⊕o)
• ES recommends against relying on the use of random GH levels to diagnose acromegaly. (1|⊕⊕⊕o)
• 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|⊕⊕⊕o)
• 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|⊕⊕oo)
• ES suggests performing formal visual field testing when the tumor is found to abut the optic chiasm on an imaging study. (2|⊕⊕⊕o)