Pitfalls in the diagnosis of acromegaly

Acromegaly is a disfiguring and disabling illness which, when inadequately treated, reduces life expectancy. An implication of the ability to offer effective treatment is the increased onus on physicians of all sorts to ensure acromegaly is diagnosed and treated as early as possible. To this end, criteria for the diagnosis of acromegaly have been proposed in the consensus statement of Giustina et al. However, other data suggest that the proposed criteria are not rigorous enough and strict adherence to the guidelines would result in failure to diagnose a significant number of patients. A review of published experience suggests that the combination of a GH nadir during an oral glucose tolerance test of <0.25 microg/l plus a normal age-related insulin growth factor-I level makes the diagnosis of acromegaly extremely unlikely.