Resumen
Definición
Anamnesis y examen
Principales factores de diagnóstico
- 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
Otros factores de diagnóstico
- fatigue
- hypertension, arrhythmias
- organomegaly
- increased appetite, polyuria/polydipsia
- headaches
- visual field defects
- signs and symptoms of hypopituitarism
- cranial nerve palsies (e.g., ophthalmoplegia)
Factores de riesgo
- GPR101 overexpression
- multiple endocrine neoplasia type 1 syndrome
- isolated familial acromegaly
- McCune-Albright syndrome
- Carney complex
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- serum insulin-like growth factor 1 (IGF-1)
- oral glucose tolerance test (OGTT)
- random serum growth hormone (GH)
- pituitary MRI or CT scan
Pruebas diagnósticas que deben considerarse
- 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
Algoritmo de tratamiento
enclosed pituitary tumor
unresectable pituitary tumor (with neural or vascular impingement/invasion)
nonpituitary adenoma etiology
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
Divulgaciones
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.
Agradecimientos
Professor Fleseriu would like to gratefully acknowledge Professor Ariel Barkan, Dr Omar Serri and Dr Sophie Vallette, previous contributors to this topic.
Divulgaciones
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 por pares
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
Divulgaciones
RDM declares that he has no competing interests.
Shlomo Melmed, MD
Senior Vice President and Dean
Cedars Sinai Medical Center
Los Angeles
CA
Divulgaciones
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
Divulgaciones
LK declares that he has no competing interests.
Agradecimiento de los revisores por pares
Los temas de BMJ Best Practice se actualizan de forma continua de acuerdo con los desarrollos en la evidencia y en las guías. Los revisores por pares listados aquí han revisado el contenido al menos una vez durante la historia del tema.
Divulgaciones
Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.
Referencias
Artículos principales
Fleseriu M, Langlois F, Lim DST, et al. Acromegaly: pathogenesis, diagnosis, and management. Lancet Diabetes Endocrinol. 2022 Nov;10(11):804-26. Resumen
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 Resumen
Giustina A, Barkhoudarian G, Beckers A, et al. Multidisciplinary management of acromegaly: a consensus. Rev Endocr Metab Disord. 2020 Dec;21(4):667-78. Resumen
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 Resumen
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. Resumen
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
Diferenciales
- acromegaloidism or pseudoacromegaly
Más DiferencialesGuías de práctica clínica
- A Pituitary Society update to acromegaly management guidelines
- A consensus on the diagnosis and treatment of acromegaly comorbidities: an update
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