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Treatment of acromegaly

Shlomo Melmed, MD
Section Editor
Peter J Snyder, MD
Deputy Editor
Kathryn A Martin, MD


Acromegaly is almost always caused by a somatotroph (growth hormone [GH]-secreting) adenoma of the pituitary gland and is associated with increased morbidity and mortality [1]. As a result, almost all patients should be treated, even those who are asymptomatic and those in whom the disorder does not seem to be progressing. One exception is a patient with a short life expectancy who is not expected to live long enough to benefit from therapy. The suggested approach to therapy is summarized in the algorithm (algorithm 1).

The treatment of acromegaly will be reviewed here. The clinical manifestations and diagnosis of acromegaly are discussed separately. (See "Causes and clinical manifestations of acromegaly" and "Diagnosis of acromegaly".)


The goals of therapy in acromegaly are to lower the serum insulin-like growth factor 1 (IGF-1) concentration to within the reference range for the patient's age and gender and to lower the serum growth hormone (GH) concentration to <1.0 ng/mL (1.0 mcg/L) as measured by immunoradiometric or chemiluminescent assay after a glucose load [2].

The IGF-1 criterion is probably better, since some patients who appear to have active disease clinically and by elevated IGF-1 concentration have serum GH values that suppress to <1.0 ng/mL [3,4]. Serum IGF-1 concentrations also correlate better than serum GH with insulin sensitivity in patients with acromegaly [5].

With normalization of serum IGF-1 concentrations, the life expectancy of patients with acromegaly is similar to that of the general population [6,7]. Therapy should also ameliorate symptoms, if any, due to the size of the somatotroph adenoma, but it should not cause hypopituitarism.

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Literature review current through: Sep 2017. | This topic last updated: May 31, 2017.
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