Acromegaly

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 23 Sep 2025

Last updated: 08 Jul 2025

Acromegaly is a rare, chronic disease caused by excessive secretion of growth hormone (GH), usually due to a pituitary somatotroph adenoma. It is associated with increased morbidity and premature mortality if not appropriately treated.

The diagnosis is often delayed. Early recognition and appropriate treatment are crucial for reducing the potentially debilitating complications of the disease.

Must be screened for in the presence of pituitary adenoma, profuse sweating, acral growth, coarsening of facial features, and when suspected in conjunction with commonly associated conditions, such as carpal tunnel syndrome, arthralgia, glucose intolerance or diabetes mellitus, amenorrhea, hypertension, and sleep apnea.

Modern surgical and pharmacologic modalities are associated with improved outcomes. Normalization of plasma insulin-like growth factor 1 (IGF-1) and a decrease of plasma GH to below 1 microgram/L bring the mortality rate to normal.

Monitoring and treatment of the comorbidities associated with acromegaly are essential for improving patient quality of life.

Definition

The term acromegaly is derived from the Greek akros (meaning extremity) and megas (large). It refers to the characteristic growth of extremities, which describes one aspect of the disease. Acromegaly is a chronic, progressive, multisystemic disease associated with significant morbidity and increased mortality. It is caused by excessive secretion of growth hormone, usually due to a pituitary somatotroph adenoma. Gigantism occurs with disease onset in childhood (prior to epiphyseal closure).

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
history or family history of inherited syndrome

Full details

Other diagnostic factors

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

Full details

Risk factors

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

Full details

Diagnostic tests

1st tests to order

serum insulin-like growth factor 1 (IGF-1)
oral glucose tolerance test (OGTT)
random serum growth hormone (GH)
pituitary MRI or CT scan

Full details

Tests to consider

GH-releasing hormone
chest and/or abdominal CT scanning
total body scintigraphy with radiolabeled somatostatin analog (octreoscan)
PET scan with radiolabeled somatostatin analog (Gallium-68 DOTATATE)
plasma cortisol
prolactin
thyroid-stimulating hormone (TSH) and free thyroxine
estradiol or testosterone
visual field testing

Full details

Treatment algorithm

ACUTE

enclosed pituitary tumor

unresectable pituitary tumor (with neural or vascular impingement/invasion)

nonpituitary adenoma etiology

ONGOING

pituitary adenoma progression or recurrence

Contributors

Authors

Maria Fleseriu, MD, FACE

Professor of Medicine (Endocrinology) and Neurological Surgery

Director

Pituitary Center

Oregon Health & Science University

Portland

Declarações

MF declares that she received grants to her institution from Chiesi (formerly Amryt), Crinetics, Ionis, and Recordati. She has received occasional scientific consulting fees from Camurus, Crinetics, Chiesi (formerly Amryt), Ipsen, and Recordati. MF is an author of a number of references cited in this topic and has served on the Board of the Pituitary Society.

Agradecimentos

Professor Fleseriu would like to gratefully acknowledge Professor Ariel Barkan, Dr Omar Serri and Dr Sophie Vallette, previous contributors to this topic.

Declarações

AB has received lecturing fees and research support from Novartis and Ipsen and is an author of several references cited in this topic. OS has received lecturing and educational program fees from Novartis Canada and is an author of a reference cited in this topic. SV has received fees for lecturing and attending a symposium and is an author of a reference cited in this topic.

Revisores

Robert D. Murray, MBBS, BSc, FRCP, MD

Consultant Endocrinologist & Honorary Senior Lecturer

Department of Endocrinology

Leeds Centre for Diabetes & Endocrinology

Leeds Teaching Hospitals NHS Trust

St James’s University Hospital

Leeds

Declarações

RDM declares that he has no competing interests.

Shlomo Melmed, MD

Senior Vice President and Dean

Cedars Sinai Medical Center

Los Angeles

Declarações

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

Laurence Kennedy, MD, FRCP

Professor and Chief

Chairman

Department of Endocrinology, Diabetes and Metabolism

Cleveland Clinic

Cleveland

Declarações

LK declares that he has no competing interests.

Créditos aos pareceristas

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Principais artigos

Fleseriu M, Langlois F, Lim DST, et al. Acromegaly: pathogenesis, diagnosis, and management. Lancet Diabetes Endocrinol. 2022 Nov;10(11):804-26. Resumo

Katznelson L, Laws ER Jr, Melmed S, et al; Endocrine Society. Acromegaly: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2014 Nov;99(11):3933-51.Texto completo Resumo

Giustina A, Barkhoudarian G, Beckers A, et al. Multidisciplinary management of acromegaly: a consensus. Rev Endocr Metab Disord. 2020 Dec;21(4):667-78. Resumo

Fleseriu M, Biller BMK, Freda PU, et al. A Pituitary Society update to acromegaly management guidelines. Pituitary. 2021 Feb;24(1):1-13.Texto completo Resumo

Giustina A, Barkan A, Beckers A, et al. A consensus on the diagnosis and treatment of acromegaly comorbidities: an update. J Clin Endocrinol Metab. 2020 Apr 1;105(4):dgz096. Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- acromegaloidism or pseudoacromegaly
Mais Diagnósticos diferenciais
Diretrizes
- A Pituitary Society update to acromegaly management guidelines
- A consensus on the diagnosis and treatment of acromegaly comorbidities: an update
Mais Diretrizes
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Acromegaly

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Treatment algorithm

enclosed pituitary tumor

unresectable pituitary tumor (with neural or vascular impingement/invasion)

nonpituitary adenoma etiology

pituitary adenoma progression or recurrence

Contributors

Authors

Maria Fleseriu, MD, FACE

Declarações

Agradecimentos

Declarações

Revisores

Robert D. Murray, MBBS, BSc, FRCP, MD

Declarações

Shlomo Melmed, MD

Declarações

Laurence Kennedy, MD, FRCP

Declarações

Créditos aos pareceristas

Declarações

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se para acessar todo o BMJ Best Practice