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Endocrinology & Metabolic

Acromegaly

Acromegaly is adult growth-hormone excess, usually from a pituitary somatotroph adenoma, producing progressive acral and facial change and important cardiovascular, metabolic, respiratory and musculoskeletal complications.

In a nutshell

Acromegaly is adult growth-hormone excess, usually from a pituitary adenoma, causing progressive enlargement of the hands, feet and face plus diabetes, hypertension, sleep apnoea, arthropathy and cardiovascular disease. Screen with IGF-1, confirm through specialist testing and treat through a pituitary MDT, often with transsphenoidal surgery.

Classic presentation

An adult whose rings and shoes no longer fit, with coarse facial features, sweating, headache or carpal tunnel syndrome; old photographs reveal gradual change.

Key points

  • IGF-1 is the useful initial test; random growth hormone is pulsatile and unreliable as a screening test.
  • Confirm and monitor using current assay-aware endocrine practice rather than memorising an unqualified threshold.
  • Transsphenoidal surgery is an important first-line option; specialist medical therapy and selected radiotherapy treat residual or unsuitable cases.
  • Cardiovascular, metabolic, respiratory, musculoskeletal and colorectal complications drive morbidity.
  • Visual symptoms or sudden severe headache require urgent pituitary assessment.

First-line investigation

Age-adjusted serum IGF-1, followed by specialist confirmation and dedicated pituitary MRI.

Management

Escalate visual or apoplexy features

  • Arrange urgent endocrine and neurosurgical assessment for visual loss, ophthalmoplegia, altered consciousness or sudden severe headache.5,1

Confirm the diagnosis

  • Use age-adjusted IGF-1 as the initial test, then specialist confirmation and pituitary MRI rather than relying on a random growth-hormone level.2,1

Control the adenoma

  • Offer pituitary MDT treatment, commonly transsphenoidal surgery when appropriate, with medical therapy for unsuitable or incompletely controlled disease.5,1,7

Find and treat complications

  • Assess and manage blood pressure, glucose, sleep apnoea, cardiac disease, arthropathy, nerve compression and colorectal risk.4,3,1

Treat residual disease

  • Use specialist medical therapy and consider radiotherapy for residual or recurrent disease that remains uncontrolled after appropriate treatment.1,7

Monitor biochemical control

  • Continue specialist follow-up with IGF-1, pituitary-axis assessment, imaging when indicated and surveillance for treatment adverse effects and comorbidity.2,1

Exam traps

  • Do not diagnose from a random growth-hormone concentration.
  • A scan showing a pituitary lesion does not establish active acromegaly; interpret imaging with IGF-1 and specialist endocrine testing.
  • The important complications are systemic, especially cardiovascular and metabolic.
  • A patient with visual loss or pituitary-apoplexy symptoms needs emergency escalation, not routine outpatient follow-up.

Illustrations

Facial features of acromegalyA clinical illustration of the acromegalic face: frontal bossing, prognathism, coarse features and prominent supraorbital ridges, ideally shown as a change over years.Philippe Chanson and Sylvie Salenave, Wikimedia Commons · CC-BY-2.0
Enlarged hands in acromegalyComparison photograph showing the broad, enlarged hand and thick fingers characteristic of acromegaly.Philippe Chanson and Sylvie Salenave, Wikimedia Commons · CC-BY-2.0

Key sources

  1. Pituitary Society update to acromegaly management guidelines (Specialist consensus on acromegaly diagnosis, surgery, medical therapy, radiotherapy, biochemical control and comorbidity surveillance; accessed 4 August 2026.)
  2. Consensus on criteria for acromegaly diagnosis and remission (Peer-reviewed consensus on biochemical diagnosis and remission criteria, including the need for assay-aware interpretation; published 2024 and accessed 4 August 2026.)Updated 1 Jan 2024
  3. The Pituitary Foundation: acromegaly (Current UK information on symptoms, diagnosis, treatment, comorbidities and specialist follow-up for acromegaly; accessed 4 August 2026.)
  4. NHS: acromegaly (Current NHS information on symptoms, complications, specialist diagnosis, treatment and follow-up; last reviewed 19 December 2024 and accessed 4 August 2026.)Updated 19 Dec 2024
  5. NICE HTG14: Endoscopic transsphenoidal pituitary adenoma resection (NICE guidance supporting use with consent, audit and governance and requiring experienced clinicians in an appropriate multidisciplinary centre; accessed 4 August 2026.)
  6. Pituitary Society consensus guideline for pituitary incidentaloma (Consensus on imaging, visual assessment and specialist management of sellar lesions near the optic apparatus; published 24 June 2025 and accessed 4 August 2026.)Updated 24 Jun 2025
  7. British National Formulary (BNF) (Current UK prescribing information for somatostatin analogues, pegvisomant and cabergoline; product-specific details must be checked at the point of care; accessed 4 August 2026.)

This page is exam revision material, not medical advice, and must not be used for patient care. Always check drug doses against the BNF and current guidance. Full disclaimer.