Table 1.

Monitoring and managing recommendations for comorbidities in patients with acromegaly (1, 14).

Comorbidities	Monitoring and managing recommendations
Skeletal and dental manifestations	Corrective surgical procedure, such as maxillofacial correction or dental malocclusion, should be postponed until GH and IGF1 levels have normalized for at least 6 months.
	Signs and symptoms of carpal tunnel syndrome should be monitored, and directed care should be considered for persistent or progressive symptoms.
	Arthropathy may persist despite long-term biochemical remission and should be managed by physical therapy, anti-inflammatory medications, or joint replacement, when appropriate.
	For osteoporosis, antiresorption therapy should be considered if improvements are not observed with the correction of GH and IGF1 excess, hypogonadism, and hypercalcemia.
Respiratory disorders	Screening tests for sleep apnea, such as formal overnight polysomnography or home overnight oximetry, should be performed if symptoms are suggestive in patients with acromegaly who have active or biochemically controlled disease.
Cardiovascular disease and cardiovascular risk factors	Despite biochemical control, hypertension may persist and blood pressure should be monitored.
	In patients with worsening glucose control while on SSA therapy, reduction of SSA dose, addition or substitution with GH-receptor antagonist, or management with antidiabetic medications should be considered.
Neoplasms	Colonoscopy should be performed in patients after diagnosis of acromegaly.
	Patients with polyps at screening or with persistently elevated IGF1 levels should have follow-up colonoscopies performed.
	Standard screening guidelines for other cancers should be followed.
Psychosocial complications	Psychological intervention and attention to quality-of-life issues should be implemented for all patients with active acromegaly.

GH, growth hormone; IGF1, insulin-like growth factor 1; SSA, somatostatin analog.