The diagnosis and management of acromegaly: a Canadian consensus report.

OBJECTIVE

To reach a Canadian consensus on the diagnosis and management of acromegaly.

DIAGNOSIS

documenting autonomous growth-hormone hypersecretion and imaging of the pituitary.

TREATMENT

surgical resection, adjunctive therapy with bromocriptine or octreotide and radiation therapy.

OUTCOMES

Reduction of the morbidity and mortality associated with acromegaly.

EVIDENCE

Review of international literature.

VALUES

Achievement of consensus among a panel of Canadian endocrinologists.

BENEFITS, HARMS AND COSTS: Acromegaly is a chronic debilitating condition that is associated with morbidity and mortality. This consensus statement is designed to improve the diagnosis and management of this rare condition in order to minimize the negative outcomes. Costs were not considered.

RECOMMENDATIONS

The diagnosis of acromegaly is established by documenting autonomous growth-hormone hypersecretion and by imaging the pituitary. Surgical resection is the cornerstone of treatment; however, adjunctive therapy is often needed. Although growth-hormone reduction is often associated with alleviation of symptoms, an attempt should also be made to normalize levels of growth hormone and its target growth factor, insulin-like growth factor-I (IGF-I). Persistent secretion of excess growth hormone and IGF-I may pose significant long-term health risks. A suggested therapeutic algorithm is provided. The ease of administration of bromocriptine should prompt a trial of therapy with this agent. The subcutaneous use of octreotide is of particular benefit to those patients with persistently high levels of growth hormone and IGF-I that cannot be suppressed by other means. Because acromegaly is relatively rare and complex, its diagnosis and treatment require the concerted efforts of an endocrinologist, an neurosurgeon and a radiation oncologist.