Guidelines for the diagnosis and treatment of acromegaly: a Canadian perspective

Acromegaly is a chronic, debilitating condition caused by excessive secreti on of growth hormone (GH). In the majority of cases the condition results f rom benign pituitary adenomas or, rarely, from ectopic production of GH-rel easing hormone. Regardless of the cause, excess GH results in physical disf igurement associated with arthropathy, diabetes, hypertension, cardiac dysf unction, obstructive sleep apnea and colonic neoplasia. The death rate for acromegalic patients is 2 to 3 times higher than that of the general popula tion, but with appropriate reduction of GH hypersecretion it tends to shift into the normal range. Treatment is thus aimed at normalizing GH secretion , eradicating or stabilizing the pituitary tumour while preserving normal p ituitary function, and managing the associated complications. The treatment modalities available to achieve these objectives include transsphenoidal s urgery, pharmacotherapy and radiation, or various combinations of these. Th is review provides an update on our current understanding of the pathophysi ology of GH hypersecretion in acromegaly, the newly defined diagnostic crit eria and the end point for a cure for acromegaly, and on new developments i n drug treatment with the advent of slow-release forms of somatostatin anal ogues and the longer-acting dopamine receptor agonists, as well as in the a rea of radiotherapy. Its main purpose is to guide any physician involved in the diagnosis and management of patients with acromegaly.