Giustina et al developed consensus criteria for evaluating therapeutic outcomes in patients with acromegaly. This can help guide further management of the patients. The authors are from multiple universities in Europe and the United States.
Control of acromegaly can be diagnosed biochemically by:
(1) serum insulin growth factor I (IGF-I) are within the age and gender-based normal reference range
(2) nadir growth hormone during an oral glucose tolerance test (75 gram) is < 1 µg/L
Measures:
(1) nadir growth hormone during an oral glucose tolerance test (75 gram)
(2) serum insulin growth factor I (IGF-I) levels
(3) clinical activity
Outcome
nadir GH
serum IGF-I
clinical activity
controlled
< 1 µg/L
normal for age and gender
no disorders
inadequately controlled
>= 1 µg/L
elevated
inactive
poor control
>= 1 µg/L
elevated
active
All patients should undergo:
(1) evaluation of growth hormone and IGF-I axis.
(2) periodic MRI
(3) evaluation of pituitary function
Therapeutic Outcome
Therapeutic Decisions
controlled
no change needed or reduce intensity
inadequately controlled
evaluate for comorbidities, then balance benefits vs risks for different therapies
poor control
increase intensity and/or change regimen
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