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Acromegaly: Biochemical diagnosis.

Luís Miguel Cardoso1, Gabriela Silva2, Bárbara Jesus3

  • 1Department of Endocrinology, Diabetes and Metabolism, Local Health Unity of Coimbra, Praceta Professor Mota Pinto, Coimbra, Portugal; Cancer Signalling and Metabolism Group, i3S - Institute for Research and Innovation in Health, University of Porto, Rua Alfredo Allen, n.º 208, Porto, Portugal; IPATIMUP - Institute of Molecular Pathology and Immunology of the University of Porto, Rua Júlio Amaral de Carvalho, n.º, Porto, Portugal.

Vitamins and Hormones
|March 30, 2026
PubMed
Summary

Diagnosing acromegaly is complex due to variable growth hormone (GH) secretion and assay issues. Insulin-like growth factor 1 (IGF-1) testing is key, but discordant results require careful interpretation and further testing like the oral glucose tolerance test (OGTT).

Keywords:
AcromegalyBiochemical diagnosisGrowth hormoneInsulin-like growth factor 1Oral glucose tolerance test

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Area of Science:

  • Endocrinology
  • Clinical Biochemistry

Background:

  • Acromegaly diagnosis is challenging due to pulsatile growth hormone (GH) secretion and assay variability.
  • Serum insulin-like growth factor 1 (IGF-1) is the primary biomarker, reflecting integrated GH levels.
  • Discordance between GH and IGF-1 occurs in up to 30% of cases, complicating diagnosis and monitoring.

Purpose of the Study:

  • To review the challenges in biochemical diagnosis of acromegaly.
  • To highlight the role of IGF-1 and the significance of discordant results.
  • To discuss adjunct diagnostic methods and future directions.

Main Methods:

  • Review of current literature on acromegaly biochemical diagnosis.
  • Analysis of factors contributing to GH and IGF-1 discordance.
  • Evaluation of diagnostic assays and emerging technologies.

Main Results:

  • IGF-1 measurement is the cornerstone but can be discordant with GH levels.
  • Factors like analytical variability, physiological states, and comorbidities influence results.
  • The oral glucose tolerance test (OGTT) is crucial for ambiguous cases.

Conclusions:

  • A context-sensitive approach integrating clinical and biochemical data is essential.
  • Advanced assays and multimodal biomarkers show promise for improved accuracy.
  • Multidisciplinary, patient-centered care is vital for optimizing acromegaly outcomes.