State-of-the-art strategies for the diagnosis and management of acromegaly

Elevation of blood levels of insulin-like growth factor I (IGF-I) is the most reliable diagnostic marker of growth hormone hypersecretion, and normalization of IGF-I levels is the principal criterion for documenting biochemical remission in patients with acromegaly. Levels of insulin-like growth hormone-binding protein 3 also may be useful in the assessment of patients whose IGF-I levels are not definitively diagnostic of active disease. When surgical therapy for acromegaly is not curative, drugs such as the dopamine agonists and somatostatin analogues can be used to manage the disease; the somatostatin analogues are more effective than the dopamine agonists. In addition, a new class of agents for the medical management of acromegaly, the growth hormone receptor antagonists, may soon be available. The importance of biochemical control of acromegaly is suggested by a study of 149 acromegalic patients who had undergone transsphenoidal surgery; for those who were not cured, a 3.5-fold increase in the relative death risk was associated with each year of active disease compared with a year in biochemical remission. Moreover, primary drug therapy, rather than surgery, may be preferred in some circumstances; for example, when surgical cure is unlikely and no acute mass effects are present.