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 mo st reliable diagnostic marker of growth hormone hypersecretion, and normali zation of IGF-I levels is the principal criterion for documenting biochemic al remission in patients with acromegaly. Levels of insulin like growth hor mone-binding protein 3 also may be useful in the assessment of patients who se IGF-I levels are not definitively diagnostic of active disease. When sur gical therapy for acromegaly is not curative, drugs such as the dopamine ag onists and somatostatin analogues can be used to manage the disease; the so matostatin analogues are more effective than the dopamine agonists. In addi tion, a new class of agents for the medical management of acromegaly, the g rowth hormone receptor antagonists, may soon be available. The importance o f biochemical control of acromegaly is suggested by a study of 149 acromega lic patients who had undergone transsphenoidal surgery; for those who were not cured, a 3.5-fold increase in the relative death risk was associated wi th each year of active disease compared with a year in biochemical remissio n. Moreover, primary drug therapy, rather than surgery, may be preferred in some circumstances; for example, when surgical cure is unlikely and no acu te mass effects are present.