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2 . 2022

Problems of diagnosis and treatment of acromegaly


The review discusses current problems of diagnosis and multidisciplinary treatment of acromegaly. The reasons contributing to the delayed detection of the disease, increased comorbidity and the formation of the status of a difficult patient with limited therapeutic maneuver capabilities are analyzed. The modern possibilities of patient- and tumor-oriented diagnosis of acromegaly, the most effective methods of primary and adjuvant therapy, as well as issues of correction of postoperative complications are covered in detail. Particular attention is paid to the topic of differentiated treatment of acromegaly syndrome, taking into account the presence of multiple pathomorphological variants of somatotroph adenomas, differing in clinical, biochemical, radiological and therapeutic characteristics. The paper emphasizes the need for further improvement of personalized predictive programs that allow predicting the course of the disease and the effectiveness of the proposed pharmacotherapy. The importance of lifelong dynamic monitoring of all patients for the purpose of operative correction of the treatment regimen and timely detection of progressive growth of a residual tumor and possible relapse is substantiated.

Keywords:acromegaly; laboratory and instrumental diagnostics; surgical and medical treatment

Funding. The study had no sponsor support.

Conflict of interest. The authors declare no conflict of interest.

For citation: Pronin V.S., Astafyeva L.I. Problems of diagnosis and treatment of acromegaly. Endokrinologiya: novosti, mneniya, obuchenie [Endocrinology: News, Opinions, Training]. 2022; 11 (2): 71–82. DOI: (in Russian)


1. Akirov A., Asa S.L., Amer L., Shimon I., Ezzat S. The clinicopathological spectrum of acromegaly. J Clin Med. 2019; 8 (11): 1962. DOI:

2. Lavrentaki A., Paluzzi A., Wass J.A.H., Karavitaki N. Epidemiology of acromegaly: review of population studies. Pituitary. 2017; 20 (1): 4–9. DOI:

3. Lopes M.B.S. The 2017 World Health Organization classification of tumors of the pituitary gland: a summary. Acta Neuropathol. 2017; 134 (4): 521–35. DOI:

4. Pedraza-Arevalo S., Gahete M.D.,Alors-Perez E., et al. Multilayered heterogeneity as an intrinsic hallmark of neuroendocrine tumors. Rev Endocr Metab Disord. 2018; 19 (2): 179–92. DOI:

5. Asa S.L., Casar-Borota O., Chanson P., et al. From pituitary adenoma to pituitary neuroendocrine tumor (PitNET): an International Pituitary Pathology Club proposal. Endocr Relat Cancer. 2017; 24: C 5–8. DOI:

6. Kasuki L., Raverot G. Definition and diagnosis of aggressive pituitary tumors. Rev Endocr Metab Disord. 2020; 21: 203–8. DOI:

7. Trouillas J., Jaffrain-Rea M-L., Vasiljevic A., et al. Are aggressive pituitary tumors and carcinomas two sides of the same coin? Pathologists reply to clinician’s questions. Rev Endocr Metab Disord. 2020; 21 (2): 243–51. DOI:

8. Trouillas J., Jaffrain-Rea M-L., Vasiljevic A., et al. How to classify pituitary neuroendocrine tumors (PitNet)s in 2020. Cancer (Basel). 2020; 12 (2): 514. DOI:

9. Shaid M., Korbonits M. Genetics of pituitary adenomas. Neurol India. 2017; 65: 577–87. DOI:

10. Colao A., Grasso L.F.S., Di Cera M., et al. Association between biochemical control and comorbidities in patients with acromegaly: an Italian longitudinal retrospective chart review study. J Endocrinol Invest. 2020; 43 (4): 529–38. DOI:

11. Gadelha M.R., Kasuki L., Lim D.S., Fleseriu M. Systemic complications of acromegaly and the impact of the current treatment landscape: an update. Endocr Rev. 2019; 40: 268–32. DOI:

12. Giustina A., Barkhoudarian G., Beckers A., Ben-Shlomo A., Biermasz N., Biller B., et al Multidisciplinary management of acromegaly: a consensus. Rev Endocr Metab Disord. 2020; 21 (4): 667–78. DOI:

13. Fleseriu M., Barcan A., del Pilar Schneider V., et al. Prevalence of comorbidities and concomitant medication use in acromegaly: analysis of real-world data from the United States. Pituitary. 2022; 25 (2): 296–307. DOI:

14. Buchfelder M., Feulner J. Neurosurgical treatment of acromegaly. Prog Mol Biol Transl Sci. 2016; 138: 115–39. DOI:

15. Sasagawa Y., Hayashi Y., Tachibana O., et al. Transsphenoidal surgery for elderly patients with acromegaly and its outcomes: comparison with younger patients. World Neurosurg. 2018; 118: e229–34. DOI:

16. Agrawal N., Ioachimescu A.G. Prognostic factors of biochemical remission after transsphenoidal surgery for acromegaly: a structured review. Pituitary. 2020; 23 (5): 582–94. DOI:

17. Gomes-Porras M., Cardenas-Salas J., Alvares-Escola C. Somatostatin analogs in clinical practice: a review. Int J Mol Sci. 2020; 21 (5): 1682. DOI:

18. Gadelha M.R., Wildemberg L.E., Kasuki L. The future of somatostatin receptor ligands in acromegaly. J Clin Endocrinol Metab. 2022; 107 (2): 297–308. DOI:

19. Salvatory R., Gordon M.B., Woodmansee W.W., Ioachimescu A.G., Carver D.W., Mirakhur B. A multicenter, observational study of lanreotide depot/autogel (LAN) in patients with acromegaly in the United States: 2-year experience from the SODA registry. Pituitary. 2017; 20 (6): 605–18. DOI:

20. Ezzat S., Caspar-Bell G.M., Chik C.L., et al. Predictive markers for postsurgical medical management of acromegaly: a systematic review and consensus treatment guideline. Endocr Pract. 2019; 25 (4): 379–93. DOI:

21. Puig-Domingo M., Bernabeu I., Pico A., et al. Pasireotide in the personalized treatment of acromegaly. Front Endocrinol (Lausanne). 2021; 12: 648411. DOI:

22. Bollerslev J., Heck A., Olarescu N.C. Management of endocrine disease: individualised management of acromegaly. Eur J Endocrinol 2019; 181 (2): 57–71. DOI:

23. Fleseriu M., Fuhrer-Sakel D., van der Lely A.J., et al. More than a decade of real-world experience of pegvisomant for acromegaly: ACROSTUDY. Eur J Endocrinol. 2021; 185 (4): 525–38. DOI:

24. Nakano-Tateno T., Lau R.J., Wang J., et al. Multimodal non-surgical treatments of aggressive pituitary tumors. Front Endocrinol (Lausanne). 2021; 12: 624686. DOI:

25. Liu W., Xie L., He M., et al. Expression of somatostatin receptor 2 in somatotropinoma correlated with the short-term efficacy of somatostatin analogues. Int J Endocrinol. 2017; 2017: 9606985. DOI:

26. Melmed S., et al. A Consensus Statement on acromegaly therapeutic outcomes. Nat Rev Endocrinol. 2018; 14 (9): 552–61. DOI:

27. Fleseriu M., Biller B.M.K., Freda P.U., Gadelha M.R., Giustina A., Katznelson L., et al. A Pituitary Society update to acromegaly management guidelines. Pituitary. 2021; 24 (1): 1–13. DOI:

28. Zarool-Hassan R., et al. Symptoms and signs of acromegaly: an ongoing need to raise awareness among healthcare practitioners. J Prim Health Care. 2016; 8 (2): 157–63. DOI:

29. Esposito D., Ragnarsson O., Johannsson G., Olsson D.S. Prolonged diagnostic delay in acromegaly is associated with increased morbidity and mortality. Eur J Endocrinol. 2020; 182 (6): 523–31. DOI:

30. Antsiferov M.B., Alekseeva T.M., Pronin E.V., Pronin V.S. Predictors of the clinical course and effectiveness of treatment of acromegaly (based on the materials of the Moscow Register). Endokrinologiya: novosti, mneniya, obuchenie [Endocrinology: News, Opinions, Training] 2020; 9 (3): 26–38. (in Russian)

31. Belaya Zh.E., Golounina O.O., Rozhinskaya L. Ya., Mel’nichenko G.A., et al. Epidemiology. clinical manifestations and effectiveness of various methods of treatment of acromegaly according to the unified Russian register of tumors of the hypothalamic-pituitary system. Problemy endokrinologii [Problems of Endocrinology]. 2020; 66 (1): 93–103. (in Russian)

32. Mete O., Cintosun A., Pressman I., Asa S.L. Epidemiology and biomarker profile of pituitary adenohypophysial tumors. Mod Pathol. 2018; 31: 900–9. DOI:

33. Miermeister C.P., Petersenn S., Buchfelder M., et al. Histological criteria for atypical pituitary adenomas – data from the German pituitary adenoma registry suggests modifications. Acta Neuropathol Commun. 2015; 3: 50. DOI:

34. Espinosa De Los Monteros A.L., Sosa-Eroza E., Gonzalez B., Mendoza V., Mercado M. Prevalence, clinical and biochemical spectrum, and treatment outcome of acromegaly with normal basal GH at diagnosis. J Clin Endocrinol Metab. 2018; 103: 3919–24. DOI:

35. Butz L.B., Sullivan S.E., Chandler W.F., Barkan A.L. «Micromegaly»: an update on the prevalence of acromegaly with apparently normal GH secretion in the modern era. Pituitary. 2016; 19: 547–51. DOI:

36. Potorac I., Beckers A., Bonneville J.F. T2-weighted MRI signal intensity as a predictor of hormonal and tumoral responses to somatostatin receptor ligands in acromegaly: a perspective. Pituitary. 2017; 20 (1): 116–20. DOI:

37. Kocak B., Durmaz E.S., Kadioglu P., et al. Predicting response to somatostatin analogues in acromegaly: machine learning-based high-dimensional quantitative texture analysis on T2-weighted MRI. Eur Radiol. 2019; 29: 2731–9. DOI:

38. Sarkar S., Chacko A.G. Surgery for acromegaly. Neurol India. 2020; 68 (suppl S 1): 44–51. DOI:

39. Kalinin P.L., Kadashev B.A., Fomichev D.V., Kutin M.A., Astaf’eva L.I., Sharipov O.I., et al. Surgical treatment of pituitary adenomas. Voprosy neyrokhirurgii imeni N.N. Burdenko [Problems of Neurosurgery named after N.N. Burdenko]. 2017; 81 (1): 95–107. (in Russian)

40. Raverot G., Burman P., McCormack A., et al. European Society of Endocrinology Clinical Practice Guidelines for the management of aggressive pituitary tumours and carcinomas. Eur J Endocrinol. 2018; 178 (1): G1–24. DOI:

41. Park S.H., Ku C.R., Moon J.H., Kim E.H., et al. Age- and sex-specific differences as predictors of surgical remission among patients with acromegaly. J Clin Endocrinol Metab. 2018; 103 (3): 909–16. DOI:

42. Ioachimescu A.G., Handa T., Goswami N., Pappy A.L. Gender differences and temporal trends over two decades in acromegaly: a single center study in 112 patients. Endocrine. 2020; 67 (2): 423–32. DOI:

43. Shaftel K.A, Cole T.S., Little A.S. National trends in hospital readmission following transsphenoidal surgery for pituitary lesions. Pituitary. 2020; 23 (2): 79–91. DOI:

44. Colao A., Auriemma R.S., Lombardi G., Pivonello R. Resistance to somatostatin analogs in acromegaly. Endocr Rev. 2011; 32: 247–71. DOI:

45. Kasuki L, Wildemberg L.E., Gadelha M. Management of endocrine disease: personalized medicine in the treatment of acromegaly. Eur J Endocrinol. 2018; 178 (3): R 89–100. DOI:

46. Asa S.L., Kucharczyk W., Ezzat S. Pituitary acromegaly: not one disease. Endocr Relat Cancer. 2017; 24 (3): C 1–4. DOI:

47. Antsiferov M.B., Alekseeva T.M., Pronin E.V., Pronin V.S. Rational pharmacotherapy of acromegaly (focus on adherence to treatment). Farmateka [Pharmateca]. 2021; (4): 24–33. (in Russian)

48. Gadelha M.R., Bronstein M.D., Brue T., et al. Pasireotide versus continued treatment with octreotide or lanreotide in patients with inadequately controlled acromegaly (PAOLA): a randomised, phase 3 trial. Lancet Diabetes Endocrinol. 2014; 2: 875–84. DOI:

49. Ku C.R., Melnikov V., Zhang Z., Lee E.J. Precision therapy in acromegaly caused by pituitary tumors: how close is it to reality? Endocrinol Metab (Seul). 2020; 35 (2): 206–16. DOI:

50. Puig-Domingo M., Marazuela M. Precision medicine in the treatment of acromegaly. Minerva Endocrinol. 2019; 44 (2): 169–75. DOI:

51. Wildemberg L.E., da Silva Camacho A.H., Miranda R.L., et al. Machine learning-based prediction model for treatment of acromegaly with first-generation somatostatin receptor ligands. J Clin Endocrinol Metab. 2021; 106 (7): 2047–56. DOI:

52. Nista F., Corica G., Castelletti L., et al. Clinical and radiological predictors of biochemical response to first-line treatment with somatostatin receptor ligands in acromegaly: a real-life perspective. Front Endocrinol (Lausanne). 2021; 12: 677919. DOI:

53. Lim D.S.T., Freseriu M. Personalized medical treatment of patients with acromegaly: a review. Endocr Pract. 2022; 28 (3): 321–32. DOI:

54. Raverot G., Dantony E., Beauvy J., et al. Risk of recurrence in pituitary neuroendocrine tumors: a prospective study using a five-tiered classification. J Clin Endocrinol Metab. 2017; 102: 3368–74. DOI:

55. Delemer B., Chanson P., Foubert L., et al. Patients lost to follow-up in acromegaly: results of the ACROSPECT study. Eur J Endocrinol. 2014; 170 (5): 791–7. DOI:

Ametov Alexander S.
Honored Scientist of the Russian Federation, Doctor of Medical Sciences, Professor, Head of Subdepartment of Endocrinology, Head of the UNESCO Network Chair on the subject «Bioethics of diabetes as a global problem» of the Russian Medical Academy of Continuous Professional Education (Moscow)
Medicine today

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