Acromegaly (suspected) and follow-up of known acromegaly
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
Suspected acromegaly
Laboratory tests
- IGF-1 (interpreted according to age; note any oral oestrogen use)
- Fasting plasma glucose (if not done within the year)if neededAbnormalities of glucose metabolism affect more than half of people with acromegaly and diabetes 20 to 35%: the PNDS (French national protocol for diagnosis and care) asks to screen for it routinely (fasting plasma glucose, HbA1c, even OGTT) [2]. Useful on the same sample if IGF-1 comes back high.
Do not order
Known acromegaly: follow-up shared with the endocrinologist
Fasting laboratory tests, at the frequency set by the endocrinologist
- IGF-1 (same laboratory, same method; on an injectable analogue, in the week before the next injection)
- Fasting plasma glucose
- HbA1c (if diabetes)if neededDiabetes is present in 20 to 35% of people with acromegaly; pasireotide may cause it and requires close glucose monitoring, especially in the first 3 months [2].
- ASTif neededFrequent, transient cytolysis on pegvisomant, rarely beyond 3 times normal (which then prompts discussion of stopping): regular monitoring of transaminases recommended [2].
- ALTif neededFrequent, transient cytolysis on pegvisomant, rarely beyond 3 times normal (which then prompts discussion of stopping): regular monitoring of transaminases recommended [2].
- Lipid profile (if not done recently)if neededAcromegaly can cause hypertriglyceridaemia and a fall in HDL cholesterol [2].
- Serum creatinine with GFR (if not done within the year)if needednon-French guidelineThe international consensus published in 2026 asks for GFR at diagnosis and then every year: acromegaly comes with glomerular hyperfiltration and an increased risk of end-stage renal disease (multiplied by 4.35 in one study, partly through diabetes and hypertension) [6]. The earlier 2021 French PNDS does not address kidney function [2].
Do not order
Sources (7)
- Centre de référence des maladies rares de l'hypophyse (CRMR HYPO). Acromégalie. Protocole national de diagnostic et de soins : synthèse à destination du médecin traitant. Septembre 2021 (publié par la HAS en octobre 2021).
- Centre de référence des maladies rares de l'hypophyse (CRMR HYPO). Acromégalie. Protocole national de diagnostic et de soins (PNDS), texte. Septembre 2021 (publié par la HAS en octobre 2021).
- Giustina A, Biermasz N, Casanueva FF, Fleseriu M, Mortini P, Strasburger C, et al. Consensus on criteria for acromegaly diagnosis and remission. Pituitary. 2024;27(1):7-22.
- National Institute for Health and Care Excellence (NICE, Royaume-Uni). Obstructive sleep apnoea/hypopnoea syndrome and obesity hypoventilation syndrome in over 16s. NICE guideline NG202, 20 août 2021.
- Ogedegbe OJ, Cheema AY, Khan MA, Junaid SZS, Erebo JK, Ayirebi-Acquah E, et al. A comprehensive review of four clinical practice guidelines of acromegaly. Cureus. 2022;14(9):e28722.
- Giustina A, di Filippo L, Fleseriu M, Pivonello R, Petersenn S, Wass J, et al. Consensus on acromegaly complications: an update. Pituitary. 2026;29(3):76.
- Melmed S, di Filippo L, Fleseriu M, Mercado M, Karavitaki N, Gurnell M, et al. Consensus on acromegaly therapeutic outcomes: an update. Nat Rev Endocrinol. 2025;21(11):718-737.