We recommend starting medical treatment with a first-generation SSA.

We suggest starting pasireotide LAR in patients who are resistant to first generation SSAs, provided that glucose metabolism is not deranged.

We recommend starting PegV in patients who are resistant or intolerant to SSA therapy after unsuccessful surgery or who are awaiting the results of radiotherapy.

We recommend early and close monitoring of glucose levels during the administration of pasireotide.

We suggest considering pasireotide for acromegaly patients with resistant headaches.

We recommend that the treatment efficacy of PegV should be monitored with IGF-I, but not GH.

We recommend regularly monitoring the tumor size, particularly in patients with large remnant and clinical aggressive disease.

We recommend monitoring liver function tests at the start of PegV treatment and during dose titration.