Enlarging hands/jaw, sleep apnea, sweating
Screen: IGF-1 (elevated; longer half-life than GH)
Confirm: Oral glucose suppression test — GH/IGF fail to suppress → then pituitary MRI
Treat: Transsphenoidal surgery → octreotide / pegvisomant / cabergoline if residual
Order set
- IGF-1
- OGTT with GH
- Pituitary MRI
- Visual fields, prolactin
Criteria
AdmitApoplexy / airway concerns
DischargeConfirmed, surgical/medical plan
Clinical detail — differentials, red flags, pitfalls, disposition
Red flags
- Visual field loss
- Sleep apnoea, cardiomyopathy
Differentials
- Pseudoacromegaly
- Constitutional features
Common mistakes
- Random GH
- MRI before biochemical confirmation
Disposition & follow-up
Transsphenoidal surgery; medical therapy for residual.
Discharge package
MedicationsMedical therapy for residual disease
Follow-upEndocrine + pituitary imaging/fields
Warning symptomsVisual change, headache
💊 Treatment detail — doses & preparation
Octreotidesomatostatin analogue
DoseVariceal bleed: 50 mcg IV bolus then 25–50 mcg/h ×2–5 d. Acromegaly: 100–200 mcg SC TDS or LAR 10–30 mg IM monthly
PreparationInfusion 500 mcg in 50 mL NS via pump; LAR depot deep IM gluteal
MonitorGlucose, gallstones, GI upset; in acromegaly — IGF-1
Cabergolinedopamine agonist
Dose0.25–0.5 mg twice weekly, titrate monthly (prolactinoma/acromegaly adjunct)
Preparation0.5 mg tablets with food
MonitorProlactin monthly, impulse-control disorders, cardiac valve (high cumulative dose)
PegvisomantGH antagonist
Dose10–30 mg SC OD if surgery fails/not candidate
PreparationDaily SC rotation of sites
MonitorIGF-1 q4–6 wk, LFTs, pituitary MRI (tumour growth)
📖 Endocrine Society AcromegalyReviewed July 2026