Acromegaly: rarely or not timely detection disease? reproductive aspects of pathology

Abstract

The article describes the issues of acromegaly diagnostics in accordance with American Association of Clinical Endocrinologists Medical Guidelines for clinical practice for the diagnosis and treatment of acromegaly – 2011 update.

The late diagnosis is a criticality problem: about 7-10 years takes after the first symptoms, which lead to a deterioration in the treatment efficiency of acromegaly and comorbid conditions, reduce the quality of patients’ life.

Clinical manifestations of acromegaly are the result of continuous impact of the hypersecretion of growth hormone (somatotropin) and, as a consequence, high levels of growth factors, mainly insulin-like growth factor-1, and the developing hypopituitarism and exposure of the tumor mass to the surrounding tissue.

Classic change of facial features, increase the size of the hands and feet, jaw changes, macroglossia, voice changes are the most well-known manifestations of acromegaly, but appear relatively late and only a small percentage of cases.

Reproductive disorders may be the first clinical manifestations of endocrine disease. Therefore, professionals managing these patients need to be informed about current screening and diagnostic algorithms, including laboratory testing.

Algorithm of laboratory examinations for the early acromegaly diagnosis includes evaluation of insulin-like growth factor-1, growth hormone levels and oral glucose suppression test. Elevated levels of insulin-like growth factor-1, the basal level of growth hormone more than 0.4 ng/ml, and the inability to suppress the secretion of growth hormone below 1 ng/ml (0.4 ng/ml as the proposed cut-off point if there are elevated levels of insulin-like growth factor-1) in the glucose load test are the basis for biochemical diagnosis of acromegaly.

Topical diagnosis of the tumor (magnetic resonance imaging of the pituitary with and without contrast agent) and additional laboratory studies of hormonal status (determination of the level of prolactin to select further tactics) are performed after the biochemical diagnosis of acromegaly.