Table 1.

Presentation, monitoring, and outcomes: summary points

Presentation, comorbidities, and mortality

Although men present at a younger age than do women, women may show both increased incidence and mortality risk. (MQ, DR) Biochemical control remains the strongest predictor of patient outcomes, reflecting improvements in glucose metabolism, OSA, cardiovascular disease, and VFs. However, structural heart and joint changes are unlikely to resolve. (MQ, DR) The observed decline in reported mortality among acromegaly patients is likely due to more effective therapies, which, in turn, yield higher biochemical control rates and reduce the likelihood of developing respiratory and cardiovascular comorbidities that increase mortality. Rate of thyroid malignancies is not greater among acromegaly patients than among those without the condition. After screening colonoscopy at diagnosis, further testing should be performed similar to the general population, as per previous recommendations. (LQ, DR)

Assays

Reference GH nadir levels after OGTT using the IDS-iSYS assay accounting for BMI, sex, and ethinylestradiol-containing oral contraceptive use confirm the importance of these factors as confounders in GH measurements. (MQ, SR) IGF-I levels measured 6 weeks postoperatively can be used in most patients to assess remission, although patients with mildly elevated IGF-I may yet normalize by 3–6 months. (MQ, SR)

Sex, age, and surgical outcomes

Women, especially when postmenopausal, may exhibit lower surgical remission rates from TSS, as they tend to have larger and more invasive tumors that are less amenable to total resection. (LQ, DR) Patient age is likely not a predictor of surgical outcomes, nor does it impact the favorable effects of postsurgical remission on alleviating disease comorbidities. (LQ, DR)

Radiotherapy outcomes

Long-term follow-up of patients treated with SRS and FRT show that approximately half achieve and maintain biochemical control. However, up to one-third of patients with normal pituitary function develop hypopituitarism, confirming the need for ongoing monitoring. (LQ, SR)

BMI body mass index; DR discretionary recommendation; FRT fractionated radiotherapy; GH growth hormone; IGF-I insulin-like growth factor I; LQ low-quality evidence; MQ medium-quality evidence; OGTT oral glucose tolerance test; OSA obstructive sleep apnea; SR strong recommendation; SRS stereotactic radiosurgery; TSS transsphenoidal surgery; VF vertebral fracture