Table 1.

Key Recommendations^*

1.	During follow-up, measurement of IGF-I levels with the same well-validated assay is recommended. Values slightly higher than a standard cut-off for age-adjusted normalization (e.g.,within 1.2–1.3 × ULN) may be considered sufficient for control of acromegaly.
2.	Prevention and control of symptoms and comorbidities is a major goal of treatment. Assessing and aggressively managing disease-associated comorbidities is recommended, with use of clinician- and patient-reported outcome measures to help standardization of follow-up strategies.
3.	Tumor resection via transsphenoidal surgery (either endocscopic or microscopic) is a safe and effective primary treatment for most patients. The primary predictors of surgical remission are tumor size, invasiveness (Knosp grade), and experience of the neurosurgeon.
4.	Medical therapy is recommended for patients who do not achieve biochemical control after surgery. Choice of therapy among dopamine agonist, SRL, and GH receptor antagonist should be individualized based on disease- and patient-specific factors known to affect therapeutic efficacy and safety.
5.	Radiotherapy is reserved for patients that have failed, are unfit for, or declined surgical and/or medical therapy. It should be administered in specialized centers to maximize efficacy and minimize long-term complications
6.	Treatment of acromegaly is best determined by a multidisciplinary team of experts within the structure of a PTCOE, preferably in a single institution with a sufficiently large referral population. Such an approach is more likely to optimize outcomes and quality of life while minimizing disease-associated morbidity and decreasing mortality.

^*These recommendations were selected among all the recommendations included in the text based on a formal vote from all authors and reflect the consensus reached within the group