This protocol addresses the next management step in acromegaly when transsphenoidal surgery has not achieved surgical remission, and the patient continues to show modest elevation of serum IGF-1 with mild signs and symptoms of growth hormone excess.
Modest elevation of serum IGF-1 with mild signs and symptoms of growth hormone excess — persisting after transsphenoidal surgery did not meet the remission threshold.
Transsphenoidal surgery was performed as primary therapy. The required surgical remission criterion — normalized serum IGF-1 and a random serum GH below 1 µg/L at 12 weeks after surgery — was not met, indicating the need for an adjuvant next step.
When surgery does not achieve remission in this mild presentation, initial adjuvant medical therapy with an oral agent from a specific drug class is the indicated next step — the complete selection, sequencing, and dosing guidance is available in the full protocol.
The biochemical targets are an age-normalized serum IGF-1 value and a random GH below 1.0 µg/L, both of which correlate with control of acromegaly.
DOI: 10.1210/jc.2014-2700
In a patient with only modest elevations of serum IGF-1 and mild signs and symptoms of GH excess, we suggest a trial of a dopamine agonist, usually cabergoline, as the initial adjuvant medical therapy.
We suggest a biochemical target goal of an age-normalized serum IGF-1 value, which signifies control of acromegaly.
We suggest using a random GH < 1.0 µg/L as a therapeutic goal, as this correlates with control of acromegaly.
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