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Review
. 2025 Jan;20(1):63-85.
doi: 10.1080/17446651.2024.2448784. Epub 2025 Jan 5.

Acromegaly: diagnostic challenges and individualized treatment

Pamela U Freda  1
Affiliations
Review

Acromegaly: diagnostic challenges and individualized treatment

Pamela U Freda. Expert Rev Endocrinol Metab. 2025 Jan.

Abstract

Introduction: Acromegaly is due in almost all cases to a GH-secreting pituitary tumor. GH and IGF-1 excesses lead to its multi-system clinical manifestations and comorbidities. Acromegaly is under-diagnosed and typically presents with advanced disease. When early or mild, clinical recognition and biochemical confirmation are especially challenging. Individualized treatment may optimize patient outcome.

Areas covered: This review covers challenges to diagnosing acromegaly and reviews therapies for acromegaly with a focus on those aspects that can be individualized.

Expert opinion: The first step in diagnosing acromegaly is recognizing it clinically. To improve this, increase awareness and education of the general population and healthcare professionals about the acromegaly phenotype is needed. Once suspected clinically, IGF-1 measurement is the initial step in making the biochemical diagnosis. GH may be < 1.0 µg/L after oral glucose suppression in early/mild cases. GH and IGF-1 should be considered in concert. Providers should be aware of conditions that can alter GH and IGF-1 levels and each assay's performance. An individualized treatment approach is best employed. Surgery is preferred as initial treatment and medical therapy as initial adjuvant therapy. In individualizing therapy, the advantages and disadvantages of each option and predictors of response to them should be considered.

Keywords: Acromegaly growth hormone; IGF-1; cabergoline; pegvisomant; radiosurgery; somatostatin receptor ligands; surgery.

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Conflict of interest statement

Declaration of Interests

The author is a recipient of a research grant from Pfizer, Inc. to Columbia University. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

References

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      * Review of acromegaly comorbidities

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