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  • Review Article
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The changing face of acromegaly—advances in diagnosis and treatment

Nature Reviews Endocrinology volume 8, pages 605–611 (2012)Cite this article

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Abstract

Acromegaly is a chronic disease characterized by the presence of a pituitary growth hormone (GH)-producing tumour, excessive secretion of growth hormone, raised levels of insulin-like growth factor I (IGF-I) and characteristic clinical presentation of acral enlargement. Over the past two decades, major advances have occurred in the understanding of some aspects of acromegaly—such as the biology of pituitary tumours, the physiology, molecular mechanisms of GH secretion and IGF-I generation, and the pathogenesis of comorbidities. Moreover, new approaches to diagnosis and surveillance (both in terms of screening and follow-up) of acromegaly have led to increases in the number of patients diagnosed with active disease, many of whom would previously have been missed. The development of sensitive assays for detecting plasma GH and IGF-I levels, as well as the widespread use of MRI for visualization of small tumours, have been major contributing factors to these improvements. Treatment advances have resulted in improved cure rates and disease control through novel neurosurgical techniques and pharmacological approaches. This Review summarizes and discusses the changes in our understanding of the epidemiology, diagnosis, treatment, and follow-up of acromegaly and its comorbidities.

Key Points

  • Technological improvements in diagnosis have enabled the identification of active acromegaly in clinically asymptomatic patients; its prevalence is, therefore, higher than previously thought

  • Diagnosis of active acromegaly requires identification of raised plasma IGF-I concentrations

  • Some patients with acromegaly have apparently normal growth hormone (GH) levels, full suppression of GH output after glucose administration, mild or absent clinical features, and small or undetectable tumour

  • Novel therapies have led to improved cure rates and control of acromegaly

  • Strict biochemical control of acromegaly and management of its comorbidities could make disease-related mortality decline towards population norms

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Figure 1: Baseline and nadir glucose-suppressed absolute GH values for different groups of patients with acromegaly (high and normal GH values) during an OGTT.

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Acknowledgements

A. Ribeiro-Oliveira Jr's research was supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico (National Counsel of Technological and Scientific Development) and FAPEMIG (Fundação de Amparo à Pesquisa do Estado de Minas Gerais).

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  1. Department of Internal Medicine, Federal University of Minas Gerais, Rua Alfredo Balena 110, Belo Horizonte, 30330-120, MG, Brazil

    Antônio Ribeiro-Oliveira Jr

  2. Departments of Medicine and Neurosurgery, Division of Metabolism, Endocrinology and Diabetes, University of Michigan Ann Arbor, 24 Frank Lloyd Wright Drive, G-1500, 4810, MI, USA

    Ariel Barkan

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Correspondence to Ariel Barkan.

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Ribeiro-Oliveira Jr, A., Barkan, A. The changing face of acromegaly—advances in diagnosis and treatment. Nat Rev Endocrinol 8, 605–611 (2012). https://doi.org/10.1038/nrendo.2012.101

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