Follow-up of treated acromegaly: similarities and differences in assessing the response to different primary treatment modalities.

The decreased survival rate previously reported in patients with acromegaly can be normalized by successful surgical and adjunctive therapy. After surgical treatment, however, abnormalities of pulsatile growth hormone (GH) secretion may persist in spite of normal insulin-like growth factor I (IGF-I) levels, and there is a significant relapse rate. Radiotherapy is effective in lowering GH levels but relatively ineffective in normalizing IGF-I levels. There are very few data on long-term outcome after medical treatment of acromegaly, although current studies of patients receiving primary medical therapy will produce further information. IGF-I level may become an increasingly important biochemical end point. The goal of therapy is to achieve a biochemical value that reverses both the morbidity and increased mortality rate without resulting in hypopituitarism.