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Current controversies in acromegaly care.

Joanna L Spencer-Segal1, Lisa Nachtigall2,3

  • 1Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes and Michigan Neuroscience Institute, University of Michigan, Ann Arbor, MI 48109, USA.

The Journal of Clinical Endocrinology and Metabolism
|April 15, 2026
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Summary

Persistent acromegaly after surgery remains common. Medical management advances improve outcomes, but controversies persist regarding diagnosis, monitoring, and personalized treatment approaches.

Keywords:
IGF-Iacromegalydiagnostic delayfacial recognitionpregnancysomatostatin receptor ligand

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Area of Science:

  • Endocrinology
  • Internal Medicine
  • Medical Research

Background:

  • Persistent acromegaly after surgery is frequent, necessitating improved medical management.
  • Current acromegaly care involves controversies in diagnosis, monitoring, and treatment strategies.

Purpose of the Study:

  • To review literature and provide recommendations on key aspects of acromegaly management.
  • To address challenges in diagnosis, biochemical monitoring, symptom variability, pregnancy, treatment response prediction, and dosing.

Main Methods:

  • Literature review of existing studies on acromegaly management.
  • Synthesis of current evidence to formulate recommendations.
  • Discussion of emerging technologies like artificial intelligence in diagnosis.

Main Results:

  • Delayed diagnosis of acromegaly increases morbidity; AI may help but faces ethical challenges.
  • Symptom variability exists even with biochemical control; clinical assessment alongside IGF-I is crucial.
  • Pregnancy in acromegaly can have good outcomes, but data on drug effects are limited.
  • Predictive algorithms for treatment response require further validation for clinical practice.

Conclusions:

  • Medical treatment options for acromegaly have advanced, yet significant controversies persist.
  • Patient-centered outcomes and personalized medicine implementation in acromegaly require further investigation.