Consensus on criteria for acromegaly diagnosis and remission
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Published:2023-11-03
Issue:1
Volume:27
Page:7-22
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ISSN:1386-341X
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Container-title:Pituitary
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language:en
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Short-container-title:Pituitary
Author:
Giustina Andrea, Biermasz Nienke, Casanueva Felipe F., Fleseriu Maria, Mortini Pietro, Strasburger Christian, van der Lely A. J., Wass John, Melmed ShlomoORCID, Banfi Giuseppe, Barkan Ariel, Beckers Albert, Bidlingmaier Martin, Boguszewski CesarORCID, Brue Thierry, Buchfelder Michael, Chanson Philippe, Chiloiro Sabrina, Colao Annamaria, Coopmans Eva, Esposito Daniela, Ferone Diego, Frara Stefano, Gadelha Mônica, Geer Eliza B., Ghigo Ezio, Greenman Yona, Gurnell Mark, Ho Ken, Ioachimescu Adriana, Johannsson Gudmundur, Jørgensen Jens Otto, Kaiser Ursula B., Karavitaki Niki, Katznelson Laurence, Lamberts Stephen, Losa Marco, Luger Anton, Luque Raúl, Maffei Pietro, Marazuela Mónica, Neggers Sebastian, Pereira Alberto, Persani Luca, Petersenn Stephan, Reincke Martin, Salvatori Roberto, Samson Susan N., Schilbach Katharina, Shimon Ilan, Tsagarakis Stylianos, Zatelli Maria Chiara,
Abstract
Abstract
Purpose
The 14th Acromegaly Consensus Conference was convened to consider biochemical criteria for acromegaly diagnosis and evaluation of therapeutic efficacy.
Methods
Fifty-six acromegaly experts from 16 countries reviewed and discussed current evidence focused on biochemical assays; criteria for diagnosis and the role of imaging, pathology, and clinical assessments; consequences of diagnostic delay; criteria for remission and recommendations for follow up; and the value of assessment and monitoring in defining disease progression, selecting appropriate treatments, and maximizing patient outcomes.
Results
In a patient with typical acromegaly features, insulin-like growth factor (IGF)-I > 1.3 times the upper limit of normal for age confirms the diagnosis. Random growth hormone (GH) measured after overnight fasting may be useful for informing prognosis, but is not required for diagnosis. For patients with equivocal results, IGF-I measurements using the same validated assay can be repeated, and oral glucose tolerance testing might also be useful. Although biochemical remission is the primary assessment of treatment outcome, biochemical findings should be interpreted within the clinical context of acromegaly. Follow up assessments should consider biochemical evaluation of treatment effectiveness, imaging studies evaluating residual/recurrent adenoma mass, and clinical signs and symptoms of acromegaly, its complications, and comorbidities. Referral to a multidisciplinary pituitary center should be considered for patients with equivocal biochemical, pathology, or imaging findings at diagnosis, and for patients insufficiently responsive to standard treatment approaches.
Conclusion
Consensus recommendations highlight new understandings of disordered GH and IGF-I in patients with acromegaly and the importance of expert management for this rare disease.
Funder
Cedars-Sinai Medical Center
Publisher
Springer Science and Business Media LLC
Subject
Endocrinology,Endocrinology, Diabetes and Metabolism
Reference128 articles.
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