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Acromegaly

  • Visão geral
  • Teoria
  • Diagnóstico
  • Tratamento
  • ACOMPANHAMENTO
  • Recursos
Última revisão: 12 Aug 2025
Última atualização: 08 Jul 2025

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • 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
Detalhes completos

Outros fatores diagnósticos

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

Fatores de risco

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

Investigações diagnósticas

Primeiras investigações a serem solicitadas

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

Investigações a serem consideradas

  • 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
Detalhes completos

Algoritmo de tratamento

AGUDA

enclosed pituitary tumor

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

nonpituitary adenoma etiology

CONTÍNUA

pituitary adenoma progression or recurrence

Colaboradores

Autores

Maria Fleseriu, MD, FACE

Professor of Medicine (Endocrinology) and Neurological Surgery

Director

Pituitary Center

Oregon Health & Science University

Portland

OR

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

UK

Declarações

RDM declares that he has no competing interests.

Shlomo Melmed, MD

Senior Vice President and Dean

Cedars Sinai Medical Center

Los Angeles

CA

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

OH

Declarações

LK declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

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.
  • Acromegaly images

  • 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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