Table 1.

Selection of key parameters associated with disease activity in acromegaly using the funnel approach

Parameters associated with acromegaly	Disease parameters (routinely) measured in clinic	Key measure of disease activitya	Selection of key parameters by exclusion criteriab
Biochemical	IGF-I, GH, prolactin, IGFBP3	IGF-I, GH, prolactin	IGF-I
Pituitary tumor	Pituitary tumor size increase/reduction, tumor invasiveness, visual field defects, headache, apoplexy	Tumor size increase/reduction, tumor invasiveness (measured by MRI), loss of vision	Tumor size increase, tumor invasiveness (measured by MRI), loss of vision
Comorbidities	Hypertension, hyperlipidemia, left ventricular hypertrophy, cardiomyopathy, congestive heart failure, arrhythmias, valvular heart disease, cardiac disease, carpal tunnel syndrome, arthritis, osteoporosis, acral changes, glucose intolerance/diabetes, hypopituitarism, colonic polyps, colonic cancer, other malignancies, sleep disturbances, OSA, menstrual abnormalities, infertility, galactorrhea, family history	Hypertension Cardiac disease Glucose intolerance/diabetes OSA Hypopituitarism	Cardiac disease (including hypertension, hyperlipidemia, or other cardiac abnormalities) Diabetes OSA
Symptoms	Headache, excessive sweating, joint pain, fatigue, soft tissue swelling, numbness or tingling of extremities, prognathism, frontal bossing, skin tags, oily skin texture, gigantism	Headache, excessive sweating, joint pain, fatigue, soft tissue swelling (measured by SSS)	Headache, excessive sweating, joint pain, fatigue, soft tissue swelling (measured by SSS)
HRQoL	Depression, pain, low energy, decreased libido, impotence, low self-esteem, social isolation	Physical and psychological (appearance and personal relations), domains covered by AcroQoL	Physical and psychological (appearance and personal relations), domains covered by AcroQoL

IGF-I insulin-like growth factor-I, GH growth hormone, IGFBP3 insulin-like growth factor-binding protein 3, MRI magnetic resonance imaging, OSA obstructive sleep apnea, SSS Signs and Symptoms Score, AcroQoL Acromegaly Quality of Life Questionnaire

^aThat could also be modified by existing treatment options (both for acromegaly and for concomitant diseases)

^bCriteria include: (i) minimal data entry requirement, (ii) exclude if not fully confirmatory of disease activity, and (iii) difficult to collect in routine practice