Consensus on criteria for acromegaly diagnosis and remission

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.

Efficacy of pasireotide LAR for acromegaly: a prolonged real-world monocentric study

“…The individual data on the reduction of IGF-1 and GH levels in responder patients are depicted in Figure 3 . The last acromegaly consensus considered biochemical remission as normalized IGF-I values ( 11 ). On the basis of this criterion at 1, 3, 6, 12 months and at last follow-up the prevalence of patients without normalized IGF-1 levels (i.e.…”

Acromegaly and Bone: An Update

“…Moreover, cortical bone damage could also explain the persistence of increased fracture risk in biochemically controlled acromegaly. The use of cholecalciferol has been associated with decreased risk of incident VFs in acromegaly [ 26 ], whereas modernly defined tight biochemical control [ 131 ] and the use of pasireotide in active acromegaly patients may also be important protective factors against skeletal events in this clinical setting [ 130 ].…”

“…On the other hand, the decrease in incident VFs under treatment with pegvisomant was closely related to biochemical disease control [ 129 ]. The observed gap in VF prevention in favor of pasireotide may be due to possible detrimental effects of high circulating GH on bone due to the mechanism of action of pegvisomant [ 131 ].…”

Early Predictors of Remission in Acromegaly Patients after Pure Endoscopic Endonasal Transsphenoidal Surgery

“…Thus a better resection may provide more decrease in postoperative hormone levels. In this regard, early random GH evaluation can determine the degree of adenoma resection and predict subsequent long-term remission 21 . Long-term excess GH exposure is associated with increased risk of comorbidity and mortality and decreased quality of life [22][23][24] .…”