Acromegaly: Diagnosis and Management in Patients Who Present with Discrepancy Between IGF-1 and GH

  • Lisa B. NachtigallEmail author


An 18-year-old woman presented with galactorrhea and was thought to have a prolactinoma. As acromegaly signs and symptoms progressed, she proved to have an elevated GH nadir on oral glucose tolerance test but IGF1 was initially normal. The disease progressed and IGF-1 became elevated over time. She required two pituitary surgeries and radiation in addition to medical therapies for acromegaly. The case of discrepancy between IGF1 and GH levels is discussed as well as the management strategy for aggressive cases of acromegaly in which disease persists after pituitary surgery.


Acromegaly Growth hormone Insulin growth factor-1 Somatostatin analogs Radiation therapy 


  1. 1.
    Melmed S. Acromegaly. N Engl J Med. 2006;355:2558–73.CrossRefPubMedGoogle Scholar
  2. 2.
    Freda PU. Monitoring of acromegaly: what should be performed when GH and IGF-1 levels are discrepant? Clin Endocrinol (Oxf). 2009;71:166–70.CrossRefGoogle Scholar
  3. 3.
    Frystyk J, Freda P, Clemmons DR. The current status of IGF-I assays—a 2009 update. Growth Horm IGF Res. 2010;20:8–18.CrossRefPubMedGoogle Scholar
  4. 4.
    Freda PU. Current concepts in the biochemical assessment of the patient with acromegaly. Growth Horm IGF Res. 2003;13:171–84.CrossRefPubMedGoogle Scholar
  5. 5.
    Cazabat L, et al. Germline inactivating mutations of the aryl hydrocarbon receptor-interacting protein gene in a large cohort of sporadic acromegaly: mutations are found in a subset of young patients with macroadenomas. Eur J Endocrinol. 2007;157:1–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Katznelson L, et al. Acromegaly: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2014;99:3933–51.CrossRefPubMedGoogle Scholar
  7. 7.
    Fleseriu M, et al. Hormonal replacement in hypopituitarism in adults: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016;101:3888–921.CrossRefPubMedGoogle Scholar
  8. 8.
    Dineen R, Stewart PM, Sherlock M. Acromegaly. QJM. 2017;110(7):411–20. pii: hcw00.PubMedGoogle Scholar
  9. 9.
    Abs R, et al. Cabergoline in the treatment of acromegaly: a study in 64 patients. J Clin Endocrinol Metab. 1998;83:374–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Chang SC, Chen CH, Lu ML. Cabergoline-induced psychotic exacerbation in schizophrenic patients. Gen Hosp Psychiatry. 2008;30:378–80.CrossRefPubMedGoogle Scholar
  11. 11.
    Barake M, et al. Investigation of impulsivity in patients on dopamine agonist therapy for hyperprolactinemia: a pilot study. Pituitary. 2014;17:150–6.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Shih HA, Loeffler JS. Radiation therapy in acromegaly. Rev Endocr Metab Disord. 2008;9:59–65.CrossRefPubMedGoogle Scholar

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Neuroendocrine UnitMassachusetts General Hospital, Harvard Medical SchoolBostonUSA

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