Materiały źródłowe

• #1 Acromegaly Symptoms, Diagnosis, Treatment, Patient Resources

  https://crinetics.com/acromegaly-symptoms-diagnosis-treatment-resources-2/

  Acromegaly develops when a benign tumor grows on the pituitary gland and secretes increased levels of growth hormone (GH) during adulthood. […] Clinical manifestations of acromegaly can vary, but in general the disease is characterized by somatic overgrowth (often bones in the hands, feet, and face), physical changes, multiple comorbidities (two or more medical conditions in a patient), and even premature mortality. […] The tumor that causes acromegaly is not only rare, but also very slow-growing, so physical changes occur over a period of several months, or even years. […] This puts the average time between the appearance of symptoms and diagnosis at 4.5 to 5 years. […] Endocrine Society clinical practice guidelines suggest screening for acromegaly by measurement of IGF-I in patients with typical clinical manifestations, but also in those who lack the typical clinical picture and have several associated conditions: sleep apnea syndrome, type 2 diabetes mellitus, debilitating arthritis, carpal tunnel syndrome, hyperhidrosis, and hypertension.

• #2 Acromegaly | Doctor

  https://patient.info/doctor/acromegaly-pro

  Due to the insidious onset and slow progression, diagnosis is often delayed, particularly in adults, by on average 4-7 years or longer, after the onset of excessive GH secretion. […] IGF-1 is recommended as the initial screen for suspected acromegaly: It has a correlation with GH levels, long half life of 15 hours and relatively stable serum levels. […] Oral glucose tolerance test is used to confirm a raised IGF-1: GH is normally inhibited by glucose. If the glucose load fails to suppress the GH level below 1.0 mcg/L this confirms the diagnosis of acromegaly. […] MRI scan of pituitary and hypothalamus: more sensitive than CT scan. […] Patients with acromegaly have an increased risk of colon cancer and thyroid cancer. […] The aim of management is to control the symptoms caused by the local effects of the tumour and those due to the excess hormone production, and to normalise hormone levels.

• #3 Acromegaly: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17743-acromegaly

  Acromegaly can develop at any age after puberty, but healthcare providers most often diagnose it during the fourth and fifth decades of life (middle age). […] Symptoms of acromegaly often show up very slowly over many years. This makes it hard to diagnose. […] Your healthcare provider may recommend you see an endocrinologist, a healthcare provider who specializes in hormone-related conditions. They’ll make a diagnosis based on your medical history, a thorough clinical evaluation and specialized tests like blood tests and imaging tests. […] If you’ve been diagnosed with acromegaly, your provider may order additional tests to see if the condition has affected other parts of your body. These tests may include: An echocardiogram to check for heart issues. Sleep study tests to check for sleep apnea. A colonoscopy to assess the health of your colon. X-rays or a DEXA (DXA) scan to check bone health.

• #4 Updates in Diagnosis and Treatment of Acromegaly

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6182922/

  Acromegaly is a rare disease, caused largely by a growth hormone (GH) pituitary adenoma. Incidence is higher than previously thought. Due to increased morbidity and mortality, if not appropriately treated, early diagnosis efforts are essential. Screening is recommended for all patients with clinical features of GH excess. […] There is increased knowledge that classical diagnostic criteria no longer apply to all, and some patients can have GH excess with normal GH response to glucose. […] Biochemical screening is the first step for an acromegaly diagnosis. Endocrine Society guidelines and experts consensus recommend using age- and sex-adjusted IGF-1 levels in combination with GH nadir during an oral glucose tolerance test (OGTT) to diagnose and rule out acromegaly. […] Measuring serum IGF-1 is usually the initial screening test.

• #5 Towards an Earlier Diagnosis of Acromegaly and Gigantism

  https://www.mdpi.com/2077-0383/10/7/1363

  Acromegaly is a rare disease and the clinical features of acromegaly develop insidiously; its diagnosis is often significantly delayed. […] Early diagnosis and proper treatment of the diseases can prevent the development of irreversible complications of the disease and improve the quality of life in patients suffering from the disease. […] A prolonged diagnostic delay is associated with increased morbidity and mortality. […] Increased awareness of acromegaly among primary care clinicians as the first-point-of-contact with the healthcare system for most patients seems to be the most important step towards an earlier detection of acromegaly. […] Diagnosis is key to fighting the debilitating effects of this condition. Delays in diagnosis only prolong suffering and the battle of the patient being in control of this disease instead of the disease being in control of the patient.

• #6 Acromegaly | UVA Health

  https://uvahealth.com/services/benign-brain-tumor/acromegaly

  Acromegaly Diagnosis Treatment at UVA Health Symptoms and signs are not always obvious. So diagnosis is usually delayed 10-15 years after the condition develops. The average age at diagnosis is 40-45 years. […] Tests done to diagnosis acromegaly include: […] Oral glucose tolerance test: This test determines whether GH levels suppress appropriately for a normal person. It’s the most reliable test for acromegaly. In this test, blood growth hormone levels are measured after drinking a glucose drink. In patients with acromegaly, GH levels either do not suppress or increase. […] Because any type of pituitary tumor may recur, regular follow up with blood tests is necessary. If a recurrent tumor is found, additional treatment is necessary.

• #7 Acromegaly – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acromegaly/diagnosis-treatment/drc-20351226

  Diagnosis involves the steps that your healthcare professional takes to find out if you have acromegaly. Your healthcare professional asks about your health history and does a physical exam. You also may need the following tests: […] IGF-1 measurement. This blood test measures the level of IGF-1 in your blood. A high IGF-1 level can mean that the level of growth hormone also is high. This can be a clue for acromegaly. […] Growth hormone suppression test. This blood test measures your growth hormone level before and after you drink a type of sugar water called glucose. In people who don’t have acromegaly, the glucose drink typically causes the growth hormone level to fall. But if you have acromegaly, your growth hormone level tends to stay high. […] Imaging tests. Magnetic resonance imaging (MRI) can help pinpoint the location and size of a tumor in your pituitary gland. If no pituitary tumors are seen, you may need more imaging tests to look for other types of tumors. Your healthcare professional also may recommend X-rays of the hands and feet. These can help check for bone growth.

• #8 Diagnosis of acromegaly – UpToDate

  https://www.uptodate.com/contents/diagnosis-of-acromegaly

  Diagnosis of acromegaly […] The diagnostic approach to acromegaly will be reviewed here. […] The diagnosis of acromegaly should be suspected in individuals who present with the typical clinical features of growth hormone (GH) excess, which include the enlargement during adulthood of the jaw (macrognathia), hands, and feet, which result in increasing shoe and glove size and the need to enlarge finger rings.

• #9 Acromegaly Symptoms, Diagnosis, Treatment, Patient Resources

  https://crinetics.com/acromegaly-symptoms-diagnosis-treatment-resources-2/

  Acromegaly develops when a benign tumor grows on the pituitary gland and secretes increased levels of growth hormone (GH) during adulthood. […] Clinical manifestations of acromegaly can vary, but in general the disease is characterized by somatic overgrowth (often bones in the hands, feet, and face), physical changes, multiple comorbidities (two or more medical conditions in a patient), and even premature mortality. […] The tumor that causes acromegaly is not only rare, but also very slow-growing, so physical changes occur over a period of several months, or even years. […] This puts the average time between the appearance of symptoms and diagnosis at 4.5 to 5 years. […] Endocrine Society clinical practice guidelines suggest screening for acromegaly by measurement of IGF-I in patients with typical clinical manifestations, but also in those who lack the typical clinical picture and have several associated conditions: sleep apnea syndrome, type 2 diabetes mellitus, debilitating arthritis, carpal tunnel syndrome, hyperhidrosis, and hypertension.

• #10 Not Recognizing Acromegaly Symptoms Delays Diagnosis

  https://yeditepehastaneleri.com/en/health-guide/diseases-treatments/what-acromegaly-disease

  Endocrinology and Metabolic Diseases Specialist said that although acromegaly disease has very distinct symptoms and signs, the diagnosis of the disease is made late and pointed out that in studies, the period from the onset of symptoms to diagnosis is delayed up to 5-10 years. […] Our expert stated that although acromegaly has very distinct symptoms and signs, research can delay the diagnosis of the disease by 5-10 years from the onset of symptoms. […] Explaining that laboratory tests and imaging methods are used together for diagnosis in patients with suspected acromegaly, our expert gave the following information: First of all, growth hormone in the blood and insulin-like growth factor-1 (IGF-1), which is synthesized in the liver under the influence of growth hormone, are examined. If the IGF-1 level is detected to be high, the growth hormone level is evaluated with a sugar loading test to confirm the diagnosis. In addition to these examinations, MRI imaging of the pituitary gland is performed to detect the tumor from which the hormone is secreted.

• #11 Acromegaly: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17743-acromegaly

  Acromegaly can develop at any age after puberty, but healthcare providers most often diagnose it during the fourth and fifth decades of life (middle age). […] Symptoms of acromegaly often show up very slowly over many years. This makes it hard to diagnose. […] Your healthcare provider may recommend you see an endocrinologist, a healthcare provider who specializes in hormone-related conditions. They’ll make a diagnosis based on your medical history, a thorough clinical evaluation and specialized tests like blood tests and imaging tests. […] If you’ve been diagnosed with acromegaly, your provider may order additional tests to see if the condition has affected other parts of your body. These tests may include: An echocardiogram to check for heart issues. Sleep study tests to check for sleep apnea. A colonoscopy to assess the health of your colon. X-rays or a DEXA (DXA) scan to check bone health.

• #12 Acromegaly Diagnosis, Symptoms & Treatment

  https://www.emedicinehealth.com/acromegaly/article_em.htm

  The choice of treatments in acromegaly depends on its cause. […] Surgery is the first treatment used for most people with excess growth hormone, regardless of the cause. […] The operation of choice for pituitary adenoma is transsphenoidal hypophysectomy. […] The growth hormone and IGF-1 levels after surgery usually indicate whether further treatment is needed. […] Acromegaly is a lifelong disease. Drug or radiation therapy typically goes on for several years. […] Early detection is the best hope of preventing severe symptoms and complications. […] Treatments for acromegaly are successful in a significant number of people.

• #13 Updates in Diagnosis and Treatment of Acromegaly

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6182922/

  Acromegaly is a rare disease, caused largely by a growth hormone (GH) pituitary adenoma. Incidence is higher than previously thought. Due to increased morbidity and mortality, if not appropriately treated, early diagnosis efforts are essential. Screening is recommended for all patients with clinical features of GH excess. […] There is increased knowledge that classical diagnostic criteria no longer apply to all, and some patients can have GH excess with normal GH response to glucose. […] Biochemical screening is the first step for an acromegaly diagnosis. Endocrine Society guidelines and experts consensus recommend using age- and sex-adjusted IGF-1 levels in combination with GH nadir during an oral glucose tolerance test (OGTT) to diagnose and rule out acromegaly. […] Measuring serum IGF-1 is usually the initial screening test.

• #14 Updates in Diagnosis and Treatment of Acromegaly

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6182922/

  Acromegaly is a rare disease, caused largely by a growth hormone (GH) pituitary adenoma. Incidence is higher than previously thought. Due to increased morbidity and mortality, if not appropriately treated, early diagnosis efforts are essential. Screening is recommended for all patients with clinical features of GH excess. […] There is increased knowledge that classical diagnostic criteria no longer apply to all, and some patients can have GH excess with normal GH response to glucose. […] Biochemical screening is the first step for an acromegaly diagnosis. Endocrine Society guidelines and experts consensus recommend using age- and sex-adjusted IGF-1 levels in combination with GH nadir during an oral glucose tolerance test (OGTT) to diagnose and rule out acromegaly. […] Measuring serum IGF-1 is usually the initial screening test.

• #15 Acromegaly – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acromegaly/diagnosis-treatment/drc-20351226

  Diagnosis involves the steps that your healthcare professional takes to find out if you have acromegaly. Your healthcare professional asks about your health history and does a physical exam. You also may need the following tests: […] IGF-1 measurement. This blood test measures the level of IGF-1 in your blood. A high IGF-1 level can mean that the level of growth hormone also is high. This can be a clue for acromegaly. […] Growth hormone suppression test. This blood test measures your growth hormone level before and after you drink a type of sugar water called glucose. In people who don’t have acromegaly, the glucose drink typically causes the growth hormone level to fall. But if you have acromegaly, your growth hormone level tends to stay high. […] Imaging tests. Magnetic resonance imaging (MRI) can help pinpoint the location and size of a tumor in your pituitary gland. If no pituitary tumors are seen, you may need more imaging tests to look for other types of tumors. Your healthcare professional also may recommend X-rays of the hands and feet. These can help check for bone growth.

• #16 Gigantism and Acromegaly Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/925446-workup

  Patients with active acromegaly have abnormal dynamics of GH secretion. Before immunoassays for insulinlike growth factor I (IGF-I) were developed, growth hormone (GH) measurement was the only method used in the biochemical assessment of the disease. […] IGF-I, however, has been the most reliable biochemical indicator of acromegaly, because of an excellent linear dose-response correlation between serum IGF-I levels and 24-hour integrated GH secretion. […] Recommendations from 2014 guidelines on the diagnosis and management of acromegaly, from the Endocrine Society, include: Measurement of IGF-I levels in patients with typical clinical manifestations of acromegaly. Measurement of IGF-I in patients without the typical clinical manifestations of acromegaly but who have several of these associated conditions: sleep apnea syndrome, type 2 diabetes mellitus, debilitating arthritis, carpal tunnel syndrome, hyperhidrosis, and hypertension. Measurement of serum IGF-I to rule out acromegaly in a patient with a pituitary mass. Use of random GH levels to diagnose acromegaly is recommended against. In patients with elevated or equivocal serum IGF-I levels, diagnosis should be confirmed by a finding of lack of suppression of GH to less than 1 g/L following documented hyperglycemia during an oral glucose load. Following biochemical diagnosis of acromegaly, an imaging study should be performed to visualize tumor size and appearance as well as parasellar extent. Magnetic resonance imaging (MRI) is the imaging modality of choice, followed by computed tomography (CT) scanning when MRI is contraindicated or unavailable.

• #17 Gigantism and Acromegaly Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/925446-workup

  As previously stated, IGF-I has been the most reliable biochemical indicator of acromegaly. An excellent linear dose-response correlation between serum IGF-I levels and 24-hour integrated GH secretion has been demonstrated. Elevated IGF-I values in a patient whose symptoms prompt appropriate clinical suspicion almost always indicate GH excess. IGF-I is useful not only in diagnosis, but also in monitoring the efficacy of therapy. […] According to the 2014 Endocrine Society guidelines on acromegaly, the following additional testing is recommended after diagnosis: Evaluation for associated comorbidities – Hypertension, diabetes mellitus, cardiovascular disease, osteoarthritis, and sleep apnea. All comorbidities should be monitored and rigorously managed. Screening colonoscopy for colon cancer. Thyroid ultrasonography if there is palpable thyroid nodularity. Assessment for hypopituitarism and hormone deficits.

• #18 Gigantism and Acromegaly Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/925446-workup

  As previously stated, IGF-I has been the most reliable biochemical indicator of acromegaly. An excellent linear dose-response correlation between serum IGF-I levels and 24-hour integrated GH secretion has been demonstrated. Elevated IGF-I values in a patient whose symptoms prompt appropriate clinical suspicion almost always indicate GH excess. IGF-I is useful not only in diagnosis, but also in monitoring the efficacy of therapy. […] According to the 2014 Endocrine Society guidelines on acromegaly, the following additional testing is recommended after diagnosis: Evaluation for associated comorbidities – Hypertension, diabetes mellitus, cardiovascular disease, osteoarthritis, and sleep apnea. All comorbidities should be monitored and rigorously managed. Screening colonoscopy for colon cancer. Thyroid ultrasonography if there is palpable thyroid nodularity. Assessment for hypopituitarism and hormone deficits.

• #19

  https://link.springer.com/article/10.1007/s11102-023-01360-1

  The 14th Acromegaly Consensus Conference was convened to consider biochemical criteria for acromegaly diagnosis and evaluation of therapeutic efficacy. […] Accurate measures of IGF-I and GH are critical to the diagnosis of acromegaly. Therefore, clinicians should know which assay is being used, which factors influence its performance, how normal ranges are obtained, and how it has been calibrated and validated. […] In a patient with typical clinical signs and symptoms of acromegaly, IGF-I 1.3 times the upper limit of normal (ULN) for age confirms the diagnosis. GH measured after overnight fasting may be useful for informing prognosis or complications, but is not required for diagnosis. […] For patients with equivocal results, IGF-I measurements can be repeated using the same validated assay, and OGTT might additionally be useful.

• #20 Acromegaly – NIDDK

  https://www.niddk.nih.gov/health-information/endocrine-diseases/acromegaly

  How do doctors diagnose acromegaly? […] Doctors most often diagnose acromegaly by ordering two blood tests that help determine if your body is making too much GH. […] IGF test. Levels of GH in the blood can change throughout the day. A reliable way to track GH in the body is by measuring the level of IGF-I in the blood. In most cases, a high IGF-I level suggests that you have acromegaly. […] Oral glucose tolerance test. To confirm the diagnosis, your doctor will order an oral glucose tolerance test. For this test, you will drink a sugary liquid. A health professional will then test your blood every half hour for 2 hours to measure growth hormone levels. The sugar in the drink will normally cause GH levels to fall. But if your body is making too much of the hormone, these levels will not go down enough thereby confirming the diagnosis of acromegaly.

• #21 Acromegaly – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acromegaly/diagnosis-treatment/drc-20351226

  Diagnosis involves the steps that your healthcare professional takes to find out if you have acromegaly. Your healthcare professional asks about your health history and does a physical exam. You also may need the following tests: […] IGF-1 measurement. This blood test measures the level of IGF-1 in your blood. A high IGF-1 level can mean that the level of growth hormone also is high. This can be a clue for acromegaly. […] Growth hormone suppression test. This blood test measures your growth hormone level before and after you drink a type of sugar water called glucose. In people who don’t have acromegaly, the glucose drink typically causes the growth hormone level to fall. But if you have acromegaly, your growth hormone level tends to stay high. […] Imaging tests. Magnetic resonance imaging (MRI) can help pinpoint the location and size of a tumor in your pituitary gland. If no pituitary tumors are seen, you may need more imaging tests to look for other types of tumors. Your healthcare professional also may recommend X-rays of the hands and feet. These can help check for bone growth.

• #22 Acromegaly – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acromegaly/diagnosis-treatment/drc-20351226

  Diagnosis involves the steps that your healthcare professional takes to find out if you have acromegaly. Your healthcare professional asks about your health history and does a physical exam. You also may need the following tests: […] IGF-1 measurement. This blood test measures the level of IGF-1 in your blood. A high IGF-1 level can mean that the level of growth hormone also is high. This can be a clue for acromegaly. […] Growth hormone suppression test. This blood test measures your growth hormone level before and after you drink a type of sugar water called glucose. In people who don’t have acromegaly, the glucose drink typically causes the growth hormone level to fall. But if you have acromegaly, your growth hormone level tends to stay high. […] Imaging tests. Magnetic resonance imaging (MRI) can help pinpoint the location and size of a tumor in your pituitary gland. If no pituitary tumors are seen, you may need more imaging tests to look for other types of tumors. Your healthcare professional also may recommend X-rays of the hands and feet. These can help check for bone growth.

• #23 Acromegaly – NIDDK

  https://www.niddk.nih.gov/health-information/endocrine-diseases/acromegaly

  How do doctors diagnose acromegaly? […] Doctors most often diagnose acromegaly by ordering two blood tests that help determine if your body is making too much GH. […] IGF test. Levels of GH in the blood can change throughout the day. A reliable way to track GH in the body is by measuring the level of IGF-I in the blood. In most cases, a high IGF-I level suggests that you have acromegaly. […] Oral glucose tolerance test. To confirm the diagnosis, your doctor will order an oral glucose tolerance test. For this test, you will drink a sugary liquid. A health professional will then test your blood every half hour for 2 hours to measure growth hormone levels. The sugar in the drink will normally cause GH levels to fall. But if your body is making too much of the hormone, these levels will not go down enough thereby confirming the diagnosis of acromegaly.

• #24 Acromegaly – NIDDK

  https://www.niddk.nih.gov/health-information/endocrine-diseases/acromegaly

  How do doctors diagnose acromegaly? […] Doctors most often diagnose acromegaly by ordering two blood tests that help determine if your body is making too much GH. […] IGF test. Levels of GH in the blood can change throughout the day. A reliable way to track GH in the body is by measuring the level of IGF-I in the blood. In most cases, a high IGF-I level suggests that you have acromegaly. […] Oral glucose tolerance test. To confirm the diagnosis, your doctor will order an oral glucose tolerance test. For this test, you will drink a sugary liquid. A health professional will then test your blood every half hour for 2 hours to measure growth hormone levels. The sugar in the drink will normally cause GH levels to fall. But if your body is making too much of the hormone, these levels will not go down enough thereby confirming the diagnosis of acromegaly.

• #25 Acromegaly | Doctor

  https://patient.info/doctor/acromegaly-pro

  Due to the insidious onset and slow progression, diagnosis is often delayed, particularly in adults, by on average 4-7 years or longer, after the onset of excessive GH secretion. […] IGF-1 is recommended as the initial screen for suspected acromegaly: It has a correlation with GH levels, long half life of 15 hours and relatively stable serum levels. […] Oral glucose tolerance test is used to confirm a raised IGF-1: GH is normally inhibited by glucose. If the glucose load fails to suppress the GH level below 1.0 mcg/L this confirms the diagnosis of acromegaly. […] MRI scan of pituitary and hypothalamus: more sensitive than CT scan. […] Patients with acromegaly have an increased risk of colon cancer and thyroid cancer. […] The aim of management is to control the symptoms caused by the local effects of the tumour and those due to the excess hormone production, and to normalise hormone levels.

• #26 Updates in Diagnosis and Treatment of Acromegaly

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6182922/

  Current widely used cut-offs for GH after OGTT are 1.0 and 0.4 ng/dL. However, these may not be accurate for all commercial assays, and method-specific values for GH cut-offs must be reported when available. […] In summary, the most important update in screening and diagnosis is an increased knowledge and acceptance of the fact that classical diagnostic criteria of acromegaly no longer apply to all patients.

• #27

  https://www.healio.com/endocrinology/neuroendocrinology/news/online/%7B859f002f-d6cd-49d9-8f4c-efd844c2d830%7D/acromegaly-diagnosis-treatment-guideline-issued-by-the-endocrine-society

  A new clinical practice guideline developed by The Endocrine Society and published the Journal of Clinical Endocrinology Metabolism addresses evaluation and management of acromegaly. […] Under diagnosis, the task force recommends measuring IGF-1 levels in patients who have facial features or large extremities associated with acromegaly. […] Biochemical screening is recommended for all patients presenting with clinical features of acromegaly, according to the guideline. Measuring an IGF-1 level is recommended as the initial screen for acromegaly because it is a marker of integrated (growth hormone) GH secretion. […] Further, the task force recommends against relying on the use of random GH levels to diagnose the condition and for confirming diagnosis by assessing lack of GH suppression following hyperglycemia during oral glucose load.

• #28 Acromegaly diagnosis – wikidoc

  https://www.wikidoc.org/index.php/Acromegaly_diagnosis

  If acromegaly is suspected, medical imaging and medical laboratory investigations are generally used together to confirm or rule out the presence of this condition. […] IGF1 provides the most sensitive and useful lab test for the diagnosis of acromegaly. A single value of the Growth hormone (GH) is not useful in view of its pulsatality (levels in the blood vary greatly even in healthy individuals). GH levels taken 2 hours after a 75 or 100 gram glucose tolerance test are helpful in the diagnosis: GH levels are suppressed below 1 g/L in normal people, and levels higher than this cutoff are confirmatory of acromegaly. […] An MRI of the brain focussing on the sella turcica after gadolinium administration allows for clear delineation of the pituitary and the hypothalamus and the location of the tumour.

• #29 Gigantism and Acromegaly Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/925446-workup

  Patients with active acromegaly have abnormal dynamics of GH secretion. Before immunoassays for insulinlike growth factor I (IGF-I) were developed, growth hormone (GH) measurement was the only method used in the biochemical assessment of the disease. […] IGF-I, however, has been the most reliable biochemical indicator of acromegaly, because of an excellent linear dose-response correlation between serum IGF-I levels and 24-hour integrated GH secretion. […] Recommendations from 2014 guidelines on the diagnosis and management of acromegaly, from the Endocrine Society, include: Measurement of IGF-I levels in patients with typical clinical manifestations of acromegaly. Measurement of IGF-I in patients without the typical clinical manifestations of acromegaly but who have several of these associated conditions: sleep apnea syndrome, type 2 diabetes mellitus, debilitating arthritis, carpal tunnel syndrome, hyperhidrosis, and hypertension. Measurement of serum IGF-I to rule out acromegaly in a patient with a pituitary mass. Use of random GH levels to diagnose acromegaly is recommended against. In patients with elevated or equivocal serum IGF-I levels, diagnosis should be confirmed by a finding of lack of suppression of GH to less than 1 g/L following documented hyperglycemia during an oral glucose load. Following biochemical diagnosis of acromegaly, an imaging study should be performed to visualize tumor size and appearance as well as parasellar extent. Magnetic resonance imaging (MRI) is the imaging modality of choice, followed by computed tomography (CT) scanning when MRI is contraindicated or unavailable.

• #30 The Biochemical Diagnosis of Acromegaly

  https://www.mdpi.com/2077-0383/10/5/1147

  Measurement of GH and IGF-1 levels is also used to determine surgical remission, response to medical treatment, and guide treatment decisions. […] While serum IGF-1 levels, basal GH values, and nadir GH after OGTT play a major role in the diagnosis, management, and treatment of patients with acromegaly, the limitations of these tests should be acknowledged for optimal use. […] According to the 2014 Endocrine Society Clinical Practice Guideline on acromegaly, lack of suppression of GH following 75 g OGTT is the gold standard diagnostic test for acromegaly and this should completed as a confirmatory test in patients with elevated or equivocal serum IGF-1 levels. […] Discordant GH and IGF-1 values with elevated IGF-1 levels but normal GH suppression following OGTT, may not definitively exclude the diagnosis.

• #31 Practical guidelines for diagnosis and treatment of acromegaly | Endocrinología y Nutrición (English Edition)

  https://www.elsevier.es/en-revista-endocrinologia-nutricion-412-articulo-practical-guidelines-for-diagnosis-treatment-S2173509313001670

  Practical guidelines for diagnosis and treatment of acromegaly […] Diagnosis is made by showing elevated GH and IGF-I levels in patients with a clinical picture suggesting the condition. Once excess GH is confirmed by biochemical tests, MRI of the hypothalamic-pituitary area should be performed to ascertain the source of excess GH. […] A diagnosis of acromegaly requires the demonstration of high GH and IGF-1 levels. GH levels are tonically elevated in acromegaly, and a random GH level less than 0.04g/L therefore rules out diagnosis, but a high random level does not imply the presence of acromegaly. […] Biochemical diagnosis is made by measuring fasting IGF-1 levels and GH levels before and after a 75g oral glucose tolerance test (OGTT). […] After OGTT, nadir GH levels less than 1g/L rule out acromegaly with most methods. […] Pituitary magnetic resonance imaging (MRI) with gadolinium contrast is the best imaging procedure for locating the source of excess GH. This technique allows for the visualization and localization of adenomas greater than 2mm in diameter in relation to the surrounding structures.

• #32 Practical guidelines for diagnosis and treatment of acromegaly | Endocrinología y Nutrición (English Edition)

  https://www.elsevier.es/en-revista-endocrinologia-nutricion-412-articulo-practical-guidelines-for-diagnosis-treatment-S2173509313001670

  Practical guidelines for diagnosis and treatment of acromegaly […] Diagnosis is made by showing elevated GH and IGF-I levels in patients with a clinical picture suggesting the condition. Once excess GH is confirmed by biochemical tests, MRI of the hypothalamic-pituitary area should be performed to ascertain the source of excess GH. […] A diagnosis of acromegaly requires the demonstration of high GH and IGF-1 levels. GH levels are tonically elevated in acromegaly, and a random GH level less than 0.04g/L therefore rules out diagnosis, but a high random level does not imply the presence of acromegaly. […] Biochemical diagnosis is made by measuring fasting IGF-1 levels and GH levels before and after a 75g oral glucose tolerance test (OGTT). […] After OGTT, nadir GH levels less than 1g/L rule out acromegaly with most methods. […] Pituitary magnetic resonance imaging (MRI) with gadolinium contrast is the best imaging procedure for locating the source of excess GH. This technique allows for the visualization and localization of adenomas greater than 2mm in diameter in relation to the surrounding structures.

• #33 Acromegaly – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acromegaly/diagnosis-treatment/drc-20351226

  Diagnosis involves the steps that your healthcare professional takes to find out if you have acromegaly. Your healthcare professional asks about your health history and does a physical exam. You also may need the following tests: […] IGF-1 measurement. This blood test measures the level of IGF-1 in your blood. A high IGF-1 level can mean that the level of growth hormone also is high. This can be a clue for acromegaly. […] Growth hormone suppression test. This blood test measures your growth hormone level before and after you drink a type of sugar water called glucose. In people who don’t have acromegaly, the glucose drink typically causes the growth hormone level to fall. But if you have acromegaly, your growth hormone level tends to stay high. […] Imaging tests. Magnetic resonance imaging (MRI) can help pinpoint the location and size of a tumor in your pituitary gland. If no pituitary tumors are seen, you may need more imaging tests to look for other types of tumors. Your healthcare professional also may recommend X-rays of the hands and feet. These can help check for bone growth.

• #34 Practical guidelines for diagnosis and treatment of acromegaly | Endocrinología y Nutrición (English Edition)

  https://www.elsevier.es/en-revista-endocrinologia-nutricion-412-articulo-practical-guidelines-for-diagnosis-treatment-S2173509313001670

  Practical guidelines for diagnosis and treatment of acromegaly […] Diagnosis is made by showing elevated GH and IGF-I levels in patients with a clinical picture suggesting the condition. Once excess GH is confirmed by biochemical tests, MRI of the hypothalamic-pituitary area should be performed to ascertain the source of excess GH. […] A diagnosis of acromegaly requires the demonstration of high GH and IGF-1 levels. GH levels are tonically elevated in acromegaly, and a random GH level less than 0.04g/L therefore rules out diagnosis, but a high random level does not imply the presence of acromegaly. […] Biochemical diagnosis is made by measuring fasting IGF-1 levels and GH levels before and after a 75g oral glucose tolerance test (OGTT). […] After OGTT, nadir GH levels less than 1g/L rule out acromegaly with most methods. […] Pituitary magnetic resonance imaging (MRI) with gadolinium contrast is the best imaging procedure for locating the source of excess GH. This technique allows for the visualization and localization of adenomas greater than 2mm in diameter in relation to the surrounding structures.

• #35 Acromegaly – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acromegaly/diagnosis-treatment/drc-20351226

  Diagnosis involves the steps that your healthcare professional takes to find out if you have acromegaly. Your healthcare professional asks about your health history and does a physical exam. You also may need the following tests: […] IGF-1 measurement. This blood test measures the level of IGF-1 in your blood. A high IGF-1 level can mean that the level of growth hormone also is high. This can be a clue for acromegaly. […] Growth hormone suppression test. This blood test measures your growth hormone level before and after you drink a type of sugar water called glucose. In people who don’t have acromegaly, the glucose drink typically causes the growth hormone level to fall. But if you have acromegaly, your growth hormone level tends to stay high. […] Imaging tests. Magnetic resonance imaging (MRI) can help pinpoint the location and size of a tumor in your pituitary gland. If no pituitary tumors are seen, you may need more imaging tests to look for other types of tumors. Your healthcare professional also may recommend X-rays of the hands and feet. These can help check for bone growth.

• #36 Acromegaly diagnosis – wikidoc

  https://www.wikidoc.org/index.php/Acromegaly_diagnosis

  If acromegaly is suspected, medical imaging and medical laboratory investigations are generally used together to confirm or rule out the presence of this condition. […] IGF1 provides the most sensitive and useful lab test for the diagnosis of acromegaly. A single value of the Growth hormone (GH) is not useful in view of its pulsatality (levels in the blood vary greatly even in healthy individuals). GH levels taken 2 hours after a 75 or 100 gram glucose tolerance test are helpful in the diagnosis: GH levels are suppressed below 1 g/L in normal people, and levels higher than this cutoff are confirmatory of acromegaly. […] An MRI of the brain focussing on the sella turcica after gadolinium administration allows for clear delineation of the pituitary and the hypothalamus and the location of the tumour.

• #37 Acromegaly Symptoms, Diagnosis, Treatment, Patient Resources

  https://crinetics.com/acromegaly-symptoms-diagnosis-treatment-resources-2/

  Pituitary MRI studies reveal that only 25% of acromegaly patients are found to have a microadenoma (tumor diameter ≤10 mm). The rest have a macroadenoma (tumor diameter > 10 mm). […] The effects on patients’ lives are myriad: Pain: The monthly injections hurt. […] Treatment goals begin with reducing mortality and increasing quality of life by reversing or reducing the severity/number of signs and symptoms, managing other diseases or conditions the patient may also have, restoring hormone levels to normal ranges with medical therapies, controlling tumor mass, and maintaining optimum function of the pituitary gland. […] At the time of detection, two-thirds of cases are macroadenomas. This may relate to diagnostic delays and poses challenges in the surgical management of these tumors. […] Currently available pharmacological interventions for the treatment of acromegaly can reduce a patient’s risk of complications and significantly improve characteristics of the condition. […] Radiation therapy is indicated if medical treatment is unsuccessful.

• #38 Acromegaly Symptoms, Diagnosis, Treatment, Patient Resources

  https://crinetics.com/acromegaly-symptoms-diagnosis-treatment-resources-2/

  Pituitary MRI studies reveal that only 25% of acromegaly patients are found to have a microadenoma (tumor diameter ≤10 mm). The rest have a macroadenoma (tumor diameter > 10 mm). […] The effects on patients’ lives are myriad: Pain: The monthly injections hurt. […] Treatment goals begin with reducing mortality and increasing quality of life by reversing or reducing the severity/number of signs and symptoms, managing other diseases or conditions the patient may also have, restoring hormone levels to normal ranges with medical therapies, controlling tumor mass, and maintaining optimum function of the pituitary gland. […] At the time of detection, two-thirds of cases are macroadenomas. This may relate to diagnostic delays and poses challenges in the surgical management of these tumors. […] Currently available pharmacological interventions for the treatment of acromegaly can reduce a patient’s risk of complications and significantly improve characteristics of the condition. […] Radiation therapy is indicated if medical treatment is unsuccessful.

• #39 Gigantism and Acromegaly Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/925446-workup

  Patients with active acromegaly have abnormal dynamics of GH secretion. Before immunoassays for insulinlike growth factor I (IGF-I) were developed, growth hormone (GH) measurement was the only method used in the biochemical assessment of the disease. […] IGF-I, however, has been the most reliable biochemical indicator of acromegaly, because of an excellent linear dose-response correlation between serum IGF-I levels and 24-hour integrated GH secretion. […] Recommendations from 2014 guidelines on the diagnosis and management of acromegaly, from the Endocrine Society, include: Measurement of IGF-I levels in patients with typical clinical manifestations of acromegaly. Measurement of IGF-I in patients without the typical clinical manifestations of acromegaly but who have several of these associated conditions: sleep apnea syndrome, type 2 diabetes mellitus, debilitating arthritis, carpal tunnel syndrome, hyperhidrosis, and hypertension. Measurement of serum IGF-I to rule out acromegaly in a patient with a pituitary mass. Use of random GH levels to diagnose acromegaly is recommended against. In patients with elevated or equivocal serum IGF-I levels, diagnosis should be confirmed by a finding of lack of suppression of GH to less than 1 g/L following documented hyperglycemia during an oral glucose load. Following biochemical diagnosis of acromegaly, an imaging study should be performed to visualize tumor size and appearance as well as parasellar extent. Magnetic resonance imaging (MRI) is the imaging modality of choice, followed by computed tomography (CT) scanning when MRI is contraindicated or unavailable.

• #40 Gigantism and Acromegaly – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/pituitary-disorders/gigantism-and-acromegaly

  Diagnosis can be made from the characteristic clinical findings. MRI of the sella is the imaging test of choice for diagnosis of pituitary adenoma. CT, MRI, or skull x-rays disclose cortical thickening, enlargement of the frontal sinuses, and enlargement and erosion of the sella turcica. X-rays of the hands show tufting of the terminal phalanges and soft-tissue thickening. […] Serum IGF-1 should be measured in patients with suspected acromegaly; IGF-1 levels are typically substantially elevated (3-fold to 10-fold), and because IGF-1 levels do not fluctuate like GH levels do, they are the simplest way to assess GH hypersecretion. IGF-1 levels also can be used to monitor response to therapy. […] Plasma GH levels are typically elevated. Blood should be taken before the patient eats breakfast (basal state); in normal people, basal GH levels are low or undetectable. Transient elevations of GH are normal, due to the pulsatile secretion of GH, and must be distinguished from pathologic hypersecretion.

• #41 Gigantism and Acromegaly – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/pituitary-disorders/gigantism-and-acromegaly

  Diagnosis can be made from the characteristic clinical findings. MRI of the sella is the imaging test of choice for diagnosis of pituitary adenoma. CT, MRI, or skull x-rays disclose cortical thickening, enlargement of the frontal sinuses, and enlargement and erosion of the sella turcica. X-rays of the hands show tufting of the terminal phalanges and soft-tissue thickening. […] Serum IGF-1 should be measured in patients with suspected acromegaly; IGF-1 levels are typically substantially elevated (3-fold to 10-fold), and because IGF-1 levels do not fluctuate like GH levels do, they are the simplest way to assess GH hypersecretion. IGF-1 levels also can be used to monitor response to therapy. […] Plasma GH levels are typically elevated. Blood should be taken before the patient eats breakfast (basal state); in normal people, basal GH levels are low or undetectable. Transient elevations of GH are normal, due to the pulsatile secretion of GH, and must be distinguished from pathologic hypersecretion.

• #42 Acromegaly – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acromegaly/diagnosis-treatment/drc-20351226

  Diagnosis involves the steps that your healthcare professional takes to find out if you have acromegaly. Your healthcare professional asks about your health history and does a physical exam. You also may need the following tests: […] IGF-1 measurement. This blood test measures the level of IGF-1 in your blood. A high IGF-1 level can mean that the level of growth hormone also is high. This can be a clue for acromegaly. […] Growth hormone suppression test. This blood test measures your growth hormone level before and after you drink a type of sugar water called glucose. In people who don’t have acromegaly, the glucose drink typically causes the growth hormone level to fall. But if you have acromegaly, your growth hormone level tends to stay high. […] Imaging tests. Magnetic resonance imaging (MRI) can help pinpoint the location and size of a tumor in your pituitary gland. If no pituitary tumors are seen, you may need more imaging tests to look for other types of tumors. Your healthcare professional also may recommend X-rays of the hands and feet. These can help check for bone growth.

• #43 Gigantism and Acromegaly – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/pituitary-disorders/gigantism-and-acromegaly

  CT or MRI of the sella should be done to look for a tumor. If a tumor is not visible, excessive secretion of pituitary GH may be due to a non-central nervous system tumor producing excessive amounts of ectopic GHRH. Demonstration of elevated levels of plasma GHRH can confirm the diagnosis. […] Screening for complications, including diabetes, heart disease, and gastrointestinal cancer, should be done at the time of diagnosis. Fasting plasma glucose levels, glycosylated Hb (HbA1C), or an oral glucose tolerance test can be done to test for diabetes. Electrocardiography and, preferably, echocardiography are done to detect heart disease. Colonoscopy is done to detect colon polyps and cancer. Follow-up screening depends on the results of the initial testing and the patient’s response to treatment.

• #44 Gigantism and Acromegaly Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/925446-workup

  As previously stated, IGF-I has been the most reliable biochemical indicator of acromegaly. An excellent linear dose-response correlation between serum IGF-I levels and 24-hour integrated GH secretion has been demonstrated. Elevated IGF-I values in a patient whose symptoms prompt appropriate clinical suspicion almost always indicate GH excess. IGF-I is useful not only in diagnosis, but also in monitoring the efficacy of therapy. […] According to the 2014 Endocrine Society guidelines on acromegaly, the following additional testing is recommended after diagnosis: Evaluation for associated comorbidities – Hypertension, diabetes mellitus, cardiovascular disease, osteoarthritis, and sleep apnea. All comorbidities should be monitored and rigorously managed. Screening colonoscopy for colon cancer. Thyroid ultrasonography if there is palpable thyroid nodularity. Assessment for hypopituitarism and hormone deficits.

• #45 Gigantism and Acromegaly Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/925446-workup

  As previously stated, IGF-I has been the most reliable biochemical indicator of acromegaly. An excellent linear dose-response correlation between serum IGF-I levels and 24-hour integrated GH secretion has been demonstrated. Elevated IGF-I values in a patient whose symptoms prompt appropriate clinical suspicion almost always indicate GH excess. IGF-I is useful not only in diagnosis, but also in monitoring the efficacy of therapy. […] According to the 2014 Endocrine Society guidelines on acromegaly, the following additional testing is recommended after diagnosis: Evaluation for associated comorbidities – Hypertension, diabetes mellitus, cardiovascular disease, osteoarthritis, and sleep apnea. All comorbidities should be monitored and rigorously managed. Screening colonoscopy for colon cancer. Thyroid ultrasonography if there is palpable thyroid nodularity. Assessment for hypopituitarism and hormone deficits.

• #46 Gigantism and Acromegaly Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/925446-workup

  As previously stated, IGF-I has been the most reliable biochemical indicator of acromegaly. An excellent linear dose-response correlation between serum IGF-I levels and 24-hour integrated GH secretion has been demonstrated. Elevated IGF-I values in a patient whose symptoms prompt appropriate clinical suspicion almost always indicate GH excess. IGF-I is useful not only in diagnosis, but also in monitoring the efficacy of therapy. […] According to the 2014 Endocrine Society guidelines on acromegaly, the following additional testing is recommended after diagnosis: Evaluation for associated comorbidities – Hypertension, diabetes mellitus, cardiovascular disease, osteoarthritis, and sleep apnea. All comorbidities should be monitored and rigorously managed. Screening colonoscopy for colon cancer. Thyroid ultrasonography if there is palpable thyroid nodularity. Assessment for hypopituitarism and hormone deficits.

• #47 Gigantism and Acromegaly Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/925446-workup

  As previously stated, IGF-I has been the most reliable biochemical indicator of acromegaly. An excellent linear dose-response correlation between serum IGF-I levels and 24-hour integrated GH secretion has been demonstrated. Elevated IGF-I values in a patient whose symptoms prompt appropriate clinical suspicion almost always indicate GH excess. IGF-I is useful not only in diagnosis, but also in monitoring the efficacy of therapy. […] According to the 2014 Endocrine Society guidelines on acromegaly, the following additional testing is recommended after diagnosis: Evaluation for associated comorbidities – Hypertension, diabetes mellitus, cardiovascular disease, osteoarthritis, and sleep apnea. All comorbidities should be monitored and rigorously managed. Screening colonoscopy for colon cancer. Thyroid ultrasonography if there is palpable thyroid nodularity. Assessment for hypopituitarism and hormone deficits.

• #48 Gigantism and Acromegaly Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/925446-workup

  As previously stated, IGF-I has been the most reliable biochemical indicator of acromegaly. An excellent linear dose-response correlation between serum IGF-I levels and 24-hour integrated GH secretion has been demonstrated. Elevated IGF-I values in a patient whose symptoms prompt appropriate clinical suspicion almost always indicate GH excess. IGF-I is useful not only in diagnosis, but also in monitoring the efficacy of therapy. […] According to the 2014 Endocrine Society guidelines on acromegaly, the following additional testing is recommended after diagnosis: Evaluation for associated comorbidities – Hypertension, diabetes mellitus, cardiovascular disease, osteoarthritis, and sleep apnea. All comorbidities should be monitored and rigorously managed. Screening colonoscopy for colon cancer. Thyroid ultrasonography if there is palpable thyroid nodularity. Assessment for hypopituitarism and hormone deficits.

• #49 Acromegaly | Doctor

  https://patient.info/doctor/acromegaly-pro

  Due to the insidious onset and slow progression, diagnosis is often delayed, particularly in adults, by on average 4-7 years or longer, after the onset of excessive GH secretion. […] IGF-1 is recommended as the initial screen for suspected acromegaly: It has a correlation with GH levels, long half life of 15 hours and relatively stable serum levels. […] Oral glucose tolerance test is used to confirm a raised IGF-1: GH is normally inhibited by glucose. If the glucose load fails to suppress the GH level below 1.0 mcg/L this confirms the diagnosis of acromegaly. […] MRI scan of pituitary and hypothalamus: more sensitive than CT scan. […] Patients with acromegaly have an increased risk of colon cancer and thyroid cancer. […] The aim of management is to control the symptoms caused by the local effects of the tumour and those due to the excess hormone production, and to normalise hormone levels.

• #50 Gigantism and Acromegaly – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/pituitary-disorders/gigantism-and-acromegaly

  CT or MRI of the sella should be done to look for a tumor. If a tumor is not visible, excessive secretion of pituitary GH may be due to a non-central nervous system tumor producing excessive amounts of ectopic GHRH. Demonstration of elevated levels of plasma GHRH can confirm the diagnosis. […] Screening for complications, including diabetes, heart disease, and gastrointestinal cancer, should be done at the time of diagnosis. Fasting plasma glucose levels, glycosylated Hb (HbA1C), or an oral glucose tolerance test can be done to test for diabetes. Electrocardiography and, preferably, echocardiography are done to detect heart disease. Colonoscopy is done to detect colon polyps and cancer. Follow-up screening depends on the results of the initial testing and the patient’s response to treatment.

• #51 Gigantism and Acromegaly – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/pituitary-disorders/gigantism-and-acromegaly

  CT or MRI of the sella should be done to look for a tumor. If a tumor is not visible, excessive secretion of pituitary GH may be due to a non-central nervous system tumor producing excessive amounts of ectopic GHRH. Demonstration of elevated levels of plasma GHRH can confirm the diagnosis. […] Screening for complications, including diabetes, heart disease, and gastrointestinal cancer, should be done at the time of diagnosis. Fasting plasma glucose levels, glycosylated Hb (HbA1C), or an oral glucose tolerance test can be done to test for diabetes. Electrocardiography and, preferably, echocardiography are done to detect heart disease. Colonoscopy is done to detect colon polyps and cancer. Follow-up screening depends on the results of the initial testing and the patient’s response to treatment.

• #52 Acromegaly: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17743-acromegaly

  Acromegaly can develop at any age after puberty, but healthcare providers most often diagnose it during the fourth and fifth decades of life (middle age). […] Symptoms of acromegaly often show up very slowly over many years. This makes it hard to diagnose. […] Your healthcare provider may recommend you see an endocrinologist, a healthcare provider who specializes in hormone-related conditions. They’ll make a diagnosis based on your medical history, a thorough clinical evaluation and specialized tests like blood tests and imaging tests. […] If you’ve been diagnosed with acromegaly, your provider may order additional tests to see if the condition has affected other parts of your body. These tests may include: An echocardiogram to check for heart issues. Sleep study tests to check for sleep apnea. A colonoscopy to assess the health of your colon. X-rays or a DEXA (DXA) scan to check bone health.

• #53 Acromegaly: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17743-acromegaly

  Acromegaly can develop at any age after puberty, but healthcare providers most often diagnose it during the fourth and fifth decades of life (middle age). […] Symptoms of acromegaly often show up very slowly over many years. This makes it hard to diagnose. […] Your healthcare provider may recommend you see an endocrinologist, a healthcare provider who specializes in hormone-related conditions. They’ll make a diagnosis based on your medical history, a thorough clinical evaluation and specialized tests like blood tests and imaging tests. […] If you’ve been diagnosed with acromegaly, your provider may order additional tests to see if the condition has affected other parts of your body. These tests may include: An echocardiogram to check for heart issues. Sleep study tests to check for sleep apnea. A colonoscopy to assess the health of your colon. X-rays or a DEXA (DXA) scan to check bone health.

• #54 Acromegaly | Recordati Rare Diseases

  https://www.recordatirarediseases.com/patient-focus/acromegaly

  Because Acromegaly is uncommon and physical changes occur very slowly, the condition sometimes takes from 3 to 6 years to be diagnosed and can lead to severe complications such as severe damage to the joints and problems affecting the cardiovascular and respiratory systems. […] Physician most often diagnose acromegaly by ordering two blood tests that help determine if the body is making too much GH. First one is IGF test. First, by measuring the level of IGF-I in the blood Levels, a reliable way to track GH in the body. A high IGF-I level suggests acromegaly. Secondly, oral glucose tolerance test will confirm the diagnosis, as growth hormone levels and blood glucose levels are connected. […] If the blood tests confirm that the body is making too much GH, imaging tests will be conduct to locate and measure the tumor that may be causing the problem. The preferred test for viewing a pituitary tumor is the magnetic resonance imaging (MRI).

• #55 Updates in Diagnosis and Treatment of Acromegaly

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6182922/

  Current widely used cut-offs for GH after OGTT are 1.0 and 0.4 ng/dL. However, these may not be accurate for all commercial assays, and method-specific values for GH cut-offs must be reported when available. […] In summary, the most important update in screening and diagnosis is an increased knowledge and acceptance of the fact that classical diagnostic criteria of acromegaly no longer apply to all patients.

• #56 Acromegaly : Symptoms, Diagnosis and Treatment : CUN

  https://www.cun.es/en/diseases-treatments/diseases/acromegaly

  Acromegaly occurs when the body produces too much growth hormone. The source of the excess hormone is almost always the pituitary gland. […] To reach a diagnosis, a thorough medical history and physical examination is essential, as well as an analysis consisting of insulin-like growth factor-I (IGF-I) or somatomedin-C levels and basal growth hormone levels. […] After analytical confirmation of excess growth hormone (GH), a magnetic resonance imaging (MRI) scan of the hypothalamic-pituitary area should be performed to confirm the origin of the excess GH. […] Delayed diagnosis of acromegaly can lead to „serious” complications in patients. Sometimes, the symptoms are identified with normal changes in aging, thus favoring its under-diagnosis.

• #57 Acromegaly – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/522

  Acromegaly is a rare, chronic disease caused by excessive secretion of growth hormone (GH), usually due to a pituitary somatotroph adenoma. It is associated with increased morbidity and premature mortality if not appropriately treated. […] The diagnosis is often delayed. Early recognition and appropriate treatment are crucial for reducing the potentially debilitating complications of the disease. […] Must be screened for in the presence of pituitary adenoma, profuse sweating, acral growth, coarsening of facial features, and when suspected in conjunction with commonly associated conditions, such as carpal tunnel syndrome, arthralgia, glucose intolerance or diabetes mellitus, amenorrhea, hypertension, and sleep apnea. […] Modern surgical and pharmacologic modalities are associated with improved outcomes. Normalization of plasma insulin-like growth factor 1 (IGF-1) and a decrease of plasma GH to below 1 microgram/L bring the mortality rate to normal.

• #58 Acromegaly Treatment | Pacific Neuroscience Institute

  https://www.pacificneuroscienceinstitute.org/blog/pituitary-disorders/acromegaly-101/

  In patients whose MRI shows significant residual tumor or recurrence that is surgically accessible, and who have not had surgery by an experienced pituitary surgery team, repeat surgery may be a reasonable option before resorting to medical therapy. […] Reversing the effects of acromegaly involves early diagnosis and appropriate treatment. […] Effective treatment aims to control hormone levels and mitigate complications. […] Acromegaly progresses slowly, often over several years, making early detection challenging. […] Diagnosing a pituitary disease is complex.

• #59 Diagnosis of acromegaly – UpToDate

  https://www.uptodate.com/contents/diagnosis-of-acromegaly

  Diagnosis of acromegaly […] The diagnostic approach to acromegaly will be reviewed here. […] The diagnosis of acromegaly should be suspected in individuals who present with the typical clinical features of growth hormone (GH) excess, which include the enlargement during adulthood of the jaw (macrognathia), hands, and feet, which result in increasing shoe and glove size and the need to enlarge finger rings.

• #60 Acromegaly – Wikipedia

  https://en.wikipedia.org/wiki/Acromegaly

  Diagnosis is by measuring growth hormone after a person has consumed a glucose solution, or by measuring insulin-like growth factor I in the blood. […] After diagnosis, medical imaging of the pituitary is carried out to determine if an adenoma is present. […] Other pituitary hormones must be assessed to address the secretory effects of the tumor, as well as the mass effect of the tumor on the normal pituitary gland. […] An MRI of the brain focusing on the sella turcica after gadolinium administration allows for clear delineation of the pituitary and the hypothalamus and the location of the tumor. […] Pseudoacromegaly is a condition with the usual acromegaloid features but without an increase in growth hormone and IGF-1.

• #61

• #62 Laboratory Information — Acromegaly Community

  https://acromegalycommunity.org/lab

  Your doctor may recommend an imaging test, such as magnetic resonance imaging (MRI) or computed tomography (CAT Scans), to help pinpoint the location and size of a tumor on your pituitary gland. If no pituitary tumors are seen, your doctor may order other imaging tests to look for nonpituitary tumors. […] While the tumor makes growth hormone, its action and effect is dependent on production of IGF-I (insulin-like growth factor-one); Blood IGF-I is produced, primarily in the liver, in response to the amount of GH made by the pituitary gland. The blood IGF-I level is a reliable indicator of overall growth hormone production. […] An elevated IGF-1 level suggests acromegaly. […] Elevated IGF-1 and GH may indicate acromegaly in adults. Increased levels of GH and IGF-1 are normal during puberty and pregnancy; during the latter, serum IGF-1 increases on average almost 2-fold. Otherwise, increased levels are most frequently due to pituitary tumors (usually benign).

• #63 Acromegaly – Wikipedia

  https://en.wikipedia.org/wiki/Acromegaly

  Diagnosis is by measuring growth hormone after a person has consumed a glucose solution, or by measuring insulin-like growth factor I in the blood. […] After diagnosis, medical imaging of the pituitary is carried out to determine if an adenoma is present. […] Other pituitary hormones must be assessed to address the secretory effects of the tumor, as well as the mass effect of the tumor on the normal pituitary gland. […] An MRI of the brain focusing on the sella turcica after gadolinium administration allows for clear delineation of the pituitary and the hypothalamus and the location of the tumor. […] Pseudoacromegaly is a condition with the usual acromegaloid features but without an increase in growth hormone and IGF-1.

• #64 Diagnosis of Acromegaly – Pituitary Foundation

  https://www.pituitary.org.uk/information/acromegaly-diagnosis/

  IGF-1 levels can also be used, as high levels are a sign of excess GH activity, which is the hallmark of acromegaly. […] After acromegaly has been diagnosed by the above testing, an MRI scan of the pituitary is used to locate and detect the size of the tumour causing excessive GH production. Usually an area of pituitary abnormality is seen on the MRI scan but occasionally the tumour is too small to be seen. Very rarely, a tumour elsewhere in the body may produce growth-hormone-releasing hormone which stimulates the pituitary to produce excessive GH. Such very rare tumours will be identified with additional CT or MRI scans. […] Further tests such as field of vision tests may be carried out to assess whether the tumour is causing any pressure on the optic nerves, as these nerves pass very close to the pituitary gland. Other blood tests may be taken to check if other pituitary hormones are affected such as cortisol, thyroid and sex hormones (adrenal, thyroid and ovary testes).

• #65

  https://link.springer.com/article/10.1007/s11154-007-9060-2

  Acromegaly is a rare and chronic condition that is characterized by sustained unregulated hypersecretion of growth hormone (GH). […] Thus, early diagnosis has proved to be crucial to improve survival and quality of life in this condition. […] Nevertheless, the current international consensus agrees that the diagnosis of acromegaly should be based on both clinical presentation and biochemical data.

• #66

  https://link.springer.com/article/10.1007/s11154-007-9060-2

  Acromegaly is a rare and chronic condition that is characterized by sustained unregulated hypersecretion of growth hormone (GH). […] Thus, early diagnosis has proved to be crucial to improve survival and quality of life in this condition. […] Nevertheless, the current international consensus agrees that the diagnosis of acromegaly should be based on both clinical presentation and biochemical data.

• #67

  https://link.springer.com/article/10.1007/s11102-023-01360-1

  The 14th Acromegaly Consensus Conference was convened to consider biochemical criteria for acromegaly diagnosis and evaluation of therapeutic efficacy. […] Accurate measures of IGF-I and GH are critical to the diagnosis of acromegaly. Therefore, clinicians should know which assay is being used, which factors influence its performance, how normal ranges are obtained, and how it has been calibrated and validated. […] In a patient with typical clinical signs and symptoms of acromegaly, IGF-I 1.3 times the upper limit of normal (ULN) for age confirms the diagnosis. GH measured after overnight fasting may be useful for informing prognosis or complications, but is not required for diagnosis. […] For patients with equivocal results, IGF-I measurements can be repeated using the same validated assay, and OGTT might additionally be useful.

• #68

  https://link.springer.com/article/10.1007/s11102-023-01360-1

  The 14th Acromegaly Consensus Conference was convened to consider biochemical criteria for acromegaly diagnosis and evaluation of therapeutic efficacy. […] Accurate measures of IGF-I and GH are critical to the diagnosis of acromegaly. Therefore, clinicians should know which assay is being used, which factors influence its performance, how normal ranges are obtained, and how it has been calibrated and validated. […] In a patient with typical clinical signs and symptoms of acromegaly, IGF-I 1.3 times the upper limit of normal (ULN) for age confirms the diagnosis. GH measured after overnight fasting may be useful for informing prognosis or complications, but is not required for diagnosis. […] For patients with equivocal results, IGF-I measurements can be repeated using the same validated assay, and OGTT might additionally be useful.

• #69

  https://link.springer.com/article/10.1007/s11102-023-01360-1

  Follow up assessments should consider biochemical evaluation of treatment effectiveness, imaging studies evaluating residual or recurrent adenoma mass, and clinical signs and symptoms of acromegaly, its complications, and comorbidities. […] 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.

• #70

  https://link.springer.com/article/10.1007/s11102-023-01360-1

  Follow up assessments should consider biochemical evaluation of treatment effectiveness, imaging studies evaluating residual or recurrent adenoma mass, and clinical signs and symptoms of acromegaly, its complications, and comorbidities. […] 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.

• #71 Acromegaly – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acromegaly/symptoms-causes/syc-20351222

  Get a healthcare checkup if you think you have symptoms of acromegaly. The condition usually develops slowly. Even family members may take a long time to notice the physical changes that happen. But it’s important for a healthcare professional to find the condition as early as possible. Treatment can help prevent serious health conditions that can happen along with acromegaly. […] Early treatment of acromegaly can prevent these complications or keep them from becoming worse. Without treatment, acromegaly and its complications can lead to early death.

• #72 Acromegaly Diagnosis, Symptoms & Treatment

  https://www.emedicinehealth.com/acromegaly/article_em.htm

  What Are the Exams and Tests for Acromegaly? […] Acromegaly is not an easy diagnosis, and it is often missed by health care providers. […] If your health care provider suspects acromegaly, he or she will order blood tests to help confirm that diagnosis. […] IGF-1 level is much more stable and predictable than growth hormone level. Thus, measurement of IGF-1 level is considered the most reliable test for acromegaly. […] After acromegaly has been confirmed by growth hormone and IGF-1 levels, you will probably undergo a CT scan or MRI of the head to confirm that you have an adenoma in your pituitary gland. […] The goals of therapy are to relieve and reverse the symptoms of acromegaly. This is done by normalizing production of growth hormone and IGF-1 and reducing the effects of the pituitary tumor on the surrounding tissues.

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