Consensus recommendations were developed based on all presentations and discussions and all participants voted on each recommendation. After brief presentations to the entire group on each topic, breakout groups discussed current practice and recommendations, and a summary of the findings was reported back to the entire group. Search terms included “acromegaly” as well as terms associated with each respective topic covered. Briefly, participants (Table 3) were assigned specific topics related to acromegaly diagnosis and follow-up and conducted comprehensive literature searches for English-language papers published between January 2015 and September 2022. The process for development of consensus recommendations by Acromegaly Consensus Group participants before and during the meeting has been described. Key points from the discussions are presented here and are summarized in Table 2. They recommended using IGF-I normalized to age but not sex for the diagnosis of acromegaly, confirmed by lack of suppression of GH < 1 µg/L during OGTT if necessary, and to use age-normalized IGF-I and random GH < 1.0 µg/L as a therapeutic goal.įollowing on studies underscoring the challenges of uniformly applying results of GH and IGF-I assays in the clinic, the 14th Acromegaly Consensus Conference held in 2022 in Stresa, Italy, once again revisited the question of how to define biochemical criteria for acromegaly diagnosis and evaluation of therapeutic efficacy. In 2014, guidelines from the Endocrine Society further adjusted these criteria. Revisiting this issue in 2010, the 7th Acromegaly Consensus Conference recommendations included two changes : (1) OGTT is not required for diagnosis if IGF-I and GH levels are clearly elevated and (2) definition of biochemical control could be adjusted to nadir GH < 0.4 µg/L during OGTT if using newer, ultrasensitive assays. ConclusionĬonsensus recommendations highlight new understandings of disordered GH and IGF-I in patients with acromegaly and the importance of expert management for this rare disease. 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. 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. Although biochemical remission is the primary assessment of treatment outcome, biochemical findings should be interpreted within the clinical context of acromegaly. 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. Random growth hormone (GH) measured after overnight fasting may be useful for informing prognosis, but is not required for diagnosis. 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. Methodsįifty-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. ![]() ![]() The 14th Acromegaly Consensus Conference was convened to consider biochemical criteria for acromegaly diagnosis and evaluation of therapeutic efficacy.
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