Last reviewed: February 2018
Last updated: March  2017



History and exam

Key diagnostic factors

  • coarsening of facial features
  • soft-tissue and skin changes
  • carpal tunnel syndrome
  • joint pain and dysfunction
  • snoring
  • alterations in sexual functioning
  • hx or Fhx of inherited syndrome

Other diagnostic factors

  • fatigue
  • HTN, arrhythmias
  • organomegaly
  • increased appetite, polyuria/polydipsia
  • headaches
  • visual field defects
  • signs and symptoms of hypopituitarism
  • cranial nerve palsies (e.g., ophthalmoplegia)

Risk factors

  • GPR101 overexpression
  • multiple endocrine neoplasia type 1 syndrome
  • isolated familial acromegaly
  • McCune-Albright syndrome
  • Carney complex

Diagnostic investigations

1st investigations to order

  • serum insulin-like growth factor 1 (IGF-1)
  • random serum growth hormone (GH)
  • oral glucose tolerance test (OGTT)
Full details

Investigations to consider

  • pituitary MRI or CT scan
  • GH-releasing hormone
  • chest and/or abdominal CT scanning
  • total body scintigraphy with radiolabeled somatostatin analog (octreoscan)
  • plasma cortisol
  • prolactin
  • TSH and free T4
  • estradiol or testosterone
  • visual field testing
Full details

Treatment algorithm


Authors VIEW ALL

Professor of Medicine and Neurosurgery

University of Michigan

Ann Arbor



AB has received lecturing fees and research support from Novartis and Ipsen and is an author of several references cited in this monograph.

Professor Ariel Barkan would like to gratefully acknowledge Dr Omar Serri and Dr Sophie Vallette, the previous contributors to this monograph. OS has received lecturing and educational program fees from Novartis Canada and is an author of a reference cited in this monograph. SV has received fees for lecturing and attending a symposium and is an author of a reference cited in this monograph.

Peer reviewers VIEW ALL

Consultant Endocrinologist & Honorary Senior Lecturer

Department of Endocrinology

Leeds Centre for Diabetes & Endocrinology

Leeds Teaching Hospitals NHS Trust

St James’s University Hospital




RDM declares that he has no competing interests.

Senior Vice President and Dean

Cedars Sinai Medical Center

Los Angeles



SM has research grants of over 6 figures USD. SM is an author of a number of references cited in this monograph.

Professor and Chief


Department of Endocrinology, Diabetes and Metabolism

Cleveland Clinic




LK declares that he has no competing interests.

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