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Acromegalia

Last reviewed: 17 Aug 2025
Last updated: 08 Jul 2025

Summary

Definition

History and exam

Key diagnostic factors

  • aspereza das características faciais
  • alterações cutâneas e do tecido mole
  • síndrome do túnel do carpo
  • disfunção e dor articulação
  • ronco
  • alterações na função sexual
  • história pessoal ou familiar de síndrome hereditária
Full details

Other diagnostic factors

  • fadiga
  • hipertensão, arritmias
  • organomegalia
  • aumento de apetite, poliúria/polidipsia
  • cefaleias
  • defeitos de campo visual
  • sinais e sintomas de hipopituitarismo
  • paralisias do nervo craniano (por exemplo, oftalmoplegia)
Full details

Risk factors

  • superexpressão de GPR101
  • síndrome da neoplasia endócrina múltipla tipo 1
  • acromegalia familiar isolada
  • Síndrome de McCune-Albright
  • Complexo de Carney
Full details

Diagnostic investigations

1st investigations to order

  • fator sérico de crescimento semelhante à insulina 1 (IGF-1)
  • teste oral de tolerância à glicose (TOTG)
  • hormônio do crescimento (GH) sérico aleatório
  • ressonância nuclear magnética (RNM) ou tomografia computadorizada (TC) da hipófise
Full details

Investigations to consider

  • hormônio liberador de GH
  • tomografia computadorizada (TC) do tórax e/ou abdominal
  • cintilografia de corpo inteiro com análogo de somatostatina radiomarcada (octreoscan)
  • PET com análogo de somatostatina radiomarcada (gálio-68 DOTATATE)
  • cortisol plasmático
  • prolactina
  • hormônio estimulante da tireoide (TSH) e tiroxina livre
  • estradiol ou testosterona
  • teste de campo visual
Full details

Treatment algorithm

ACUTE

tumor hipofisário oculto

tumor hipofisário irressecável (com pinçamento/invasão vascular ou neural)

etiologia do adenoma não hipofisário

ONGOING

progressão ou recorrência do adenoma hipofisário

Contributors

Authors

Maria Fleseriu, MD, FACE

Professor of Medicine (Endocrinology) and Neurological Surgery

Director

Pituitary Center

Oregon Health & Science University

Portland

OR

Disclosures

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.

Acknowledgements

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

Disclosures

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.

Peer reviewers

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

Disclosures

RDM declares that he has no competing interests.

Shlomo Melmed, MD

Senior Vice President and Dean

Cedars Sinai Medical Center

Los Angeles

CA

Disclosures

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

Disclosures

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.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

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

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.Full text  Abstract

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

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

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. Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Acromegalia images
  • Differentials

    • acromegalia ou pseudoacromegalia
    More Differentials
  • Guidelines

    • A Pituitary Society update to acromegaly management guidelines
    • A consensus on the diagnosis and treatment of acromegaly comorbidities: an update
    More Guidelines
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