Does attainment of target levels of growth hormone and insulin-like growth factor I improve acromegaly prognosis?

Abstract

For almost a decade, treatment goals for acromegaly have been those recommended by an expert group—achievement of serum growth hormone (GH) levels <2.5 µg/l and age-adjusted, normal levels of insulin-like growth factor I (IGF-I). This Practice Point commentary discusses a meta-analysis by Holdaway et al. that investigated the relationship between mortality and levels of GH and IGF-I in patients with acromegaly. The findings of the study confirm that the current criteria are adequate in terms of mortality, and that the prognosis of acromegaly has improved in the past 20 years. This improvement may be related to the comparatively aggressive treatment of the disease and management of comorbidities. Changes in the methods used by clinicians to measure GH levels probably require new criteria to be adopted, as good control of acromegaly is now more adequately defined as serum GH levels <1 µg/l and age-adjusted normal levels of IGF-I.