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. 2024 Feb;27(1):7-22.
doi: 10.1007/s11102-023-01360-1. Epub 2023 Nov 3.

Consensus on criteria for acromegaly diagnosis and remission

Andrea Giustina  1 , Nienke Biermasz  2 , Felipe F Casanueva  3 , Maria Fleseriu  4 , Pietro Mortini  1 , Christian Strasburger  5 , A J van der Lely  6 , John Wass  7 , Shlomo Melmed  8 ; Acromegaly Consensus Group
Collaborators, Affiliations

Consensus on criteria for acromegaly diagnosis and remission

Andrea Giustina et al. Pituitary. 2024 Feb.

Erratum in

  • Correction: consensus on criteria for acromegaly diagnosis and remission.
    Giustina A, Biermasz N, Casanueva FF, Fleseriu M, Mortini P, Strasburger C, van der Lely AJ, Wass J, Melmed S; Acromegaly Consensus Group. Giustina A, et al. Pituitary. 2024 Feb;27(1):88. doi: 10.1007/s11102-023-01373-w. Epub 2023 Dec 6. Pituitary. 2024. PMID: 38052967 Free PMC article. No abstract available.

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.

Keywords: Acromegaly; Assays; Diagnosis; Growth hormone; Insulin-like growth factor I; Remission criteria.

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Conflict of interest statement

AB, MB, AG, and RS are Editors of Pituitary. NB, CB, TB, FC, PC, MF, SF, MG, MG, YG, KH, AI, GJ, JOJ, LK, NK, RL, PM, SN, SP, CS, IS, SLS, and AJvdL are Editorial Board Members of Pituitary. SM is Editor-in-Chief of Pituitary. MB has received research support, consultancy, and/or lecture fees from Camurus, Chiasma, Crinetics Pharmaceuticals, Diasorin, IDS, Ionis, IPSEN, Midatech, Novartis, Ono, OPKO, Pfizer, Recordati, Roche, and StrongBridge. CB has received support for investigator-initiated clinical trials from Crinetics and served as speaker or consultant for Ipsen, Recordati, and NovoNordisk. TB has received support for research grants from Pfizer, consultant/speaker agreements with Ipsen and Pfizer, and clinical trials for Crinetics and Debiopharm. PC has received unrestricted research and educational grants from Ipsen, Novartis, and Pfizer, Recordati, and Advanz; has served as an investigator for clinical trials funded by Crinetics, Chiasma, and Debiopharm; is a member of Advisory Boards for Ipsen, Pfizer, Crinetics, Recordati, and Amolyt; and is a speaker for Ipsen, Recordati, and Pfizer. SC has served as an investigator for clinical trials funded by Novartis, Pfizer, Ipsen, and Crinetics; received grants to the institution from Pfizer, Ipsen, and Recordati; and served as an Advisory Board member for Recordati. DE has received lecture fees from Ipsen and Pfizer AB. MF has received grants to the institution from Amryt, Crinetics, Ionis, and Recordati, and occasional consulting fees from Amryt, Camurus, Crinetics, Ipsen, and Recordati. MF has served as an Advisory Board member for Recordati, Crinetics and Ipsen, received speaker fees from Recordati and Ipsen, and served as principal investigator for studies funded by Recordati and Crinetics. SF has received consultancy and speaker fees from Ipsen, Pfizer, Novartis, and Recordati. BG has received research grants to the institution from Amryt/Chiesi and Ionis, and served as an occasional consultant to Amryt/Chiesi and Crinetics. AG has served as a consultant for Ipsen, Pfizer and Recordati and received research grants to the institution from Pfizer and Recordati. MG has served as a member of a speakers bureau for Ipsen Ltd UK and Pfizer. AI has served as principal investigator for institution-directed research grants from Recordati, Xeris and Amryt/Chiesi, and as an occasional consultant for Recordati, Xeris, Amryt/Chiesi, Camurus, and Crinetics. GJ has served as consultant for NovoNordisk and AstraZeneca and received lecture fees from NovoNordisk and Pfizer. JOJ has received lecture fees and unrestricted research grants from Pfizer and Novo Nordisk. PM has received speaker and/or consultancy fees from Pfizer. UBK has served as consultant for ModeX Therapeutics. LK has served as advisor for Camarus, Novo Nordisk, and Strongbridge, and received research funding from Camurus. NK has served as speaker for Pfizer, Ipsen, and Recordati Rare Diseases; as an investigator for Pfizer and Ipsen; and as a Scientific Advisory Board member for Pfizer, Ipsen, and Recordati Rare Diseases. AL has received honoraria for presentations from Pfizer and Ipsen. MM has served on advisory boards and as a speaker for Ipsen, Recordati, and Pfizer. PM has served as principal investigator, and has received consultation fees and research grants from Pfizer, Recordati, and Camurus. SM has received grants to the institution from Recordati and served as an adviser to Recordati, Crinetics, and Ionis. SN has received research grants Pfizer and consultancy grants from Recordati, NovoNordisk, and Crinetics. LP has received congress fees from Merck and Sandoz. SP has served as a speaker at workshops and Advisory Boards for Ipsen, Pfizer, and Recordati. MR has received consulting fees from Crinetics and Ipsen. CS has received speaker fees from Pfizer, and served as an advisor to Debiopharm, NovoNordisk, Chiasma, and Crinetics. IS has served as an investigator for Crinetics, Chiasma, and Debiopharm, and as speaker and consultant for Pfizer, Medison, and NovoNordisk. RS has served as a consultant for NovoNordisk, Amryt, and Camurus. SLS has served as principal investigator and conducted research studies supported by Novartis and Chiasma. ST has received grants to the institution from Crinetics, honoraria for lectures/presentations from Recordati, and support for attending meetings and/or travel from Pfizer, Ipsen, and Recordati, and has served as an Advisory Board member for Pfizer and Recordati. AJvdL has received speaker and/or consultancy fees from Pfizer, Ipsen, Crinetics, Tiburio, and Amolyt Pharma SA. All other authors declare no competing interests.

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