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. [1]. 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 µg/l plus a normal age-related insulin growth factor-I level makes the diagnosis of acromegaly extremely unlikely.

1.
Giustina A, Barkan A, Casanueva FF, Cavagnini F, Frohman L, Ho K, Veldhuis J, Was J, Von Werder K, Melmed S: Criteria for cure of acromegaly: a consensus statement. J Clin Endocrinol Metab 2000;85:526–529.
2.
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Holdaway IM, Rajasoorya CR, Gamble GD: Factors influencing mortality in acromegaly. J Clin Endocrinol Metab 2004;89:667–674.
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10.
van der Lely AJ, Hutson RK, Trainer PJ, Besser GM, Barkan AL, Katznelson L, Klibanski A, Herman-Bonert V, Melmed S, Vance ML, Freda PU, Stewart PM, Friend KE, Clemmons DR, Johannsson G, Stavrou S, Cook DM, Phillips LS, Strasburger CJ, Hackett S, Zib KA, Davis RJ, Scarlett JA, Thorner MO: Long-term treatment of acromegaly with pegvisomant, a growth hormone receptor antagonist. Lancet 2001;358:1754–1759.
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Drange MR, Fram NR, Herman-Bonert V, Melmed S: Pituitary tumor registry: a novel clinical resource. J Clin Endocrinol Metab 2000;85:168–174.
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Freda PU, Nuruzzaman AT, Reyes CM, Sundeen RE, Post KD: Significance of ‘abnormal’ nadir growth hormone levels after oral glucose in postoperative patients with acromegaly in remission with normal insulin-like growth factor-I levels. J Clin Endocrinol Metab 2004;89:495–500.
14.
Costa ACF, Rossi A, Martinelli CE, Machado HR, Moreira AC: Assessment of disease activity in treated acromegalic patients using sensitive GH assay: should we achieve strict normal GH levels for a biochemical cure? J Clin Endocrinol Metab 2002;87:3142–3147.
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18.
Ellis AR, Seth J, Al-Sadie R, Barth JH: An audit of the laboratory interpretation of GH response to insulin-induced hypoglycaemia in the assessment of short stature in children. Ann Clin Biochem 2003;40:239–243.
19.
Wieringa GE, Barth JH, Trainer PJ: GH assay standardisation: a biased view. Clin Endocrinol (Oxf) 2004;60:538–539.
20.
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21.
Bristow AF, Jespersen AM: The second international standard for somatropin (recombinant DNA-derived human growth hormone): preparation and calibration in an international collaborative study. Biologicals 2001;29:97–106.
22.
Melmed S: Confusion in clinical laboratory GH and IGF-I reports. Pituitary 1999;2:171–172.
23.
Brabant G, von zur Mühlen, Wüster C, Ranke MB, Kratzsch J, Kiess W, Ketelslegers JM, Wilhelmsen L, Hulthen L, Saller B, Mattsson A, Wilde J, Schemer R, Kann P: Serum insulin-like growth factor-I reference values for an automated chemiluminescence immunoassay system: results from multicenter study. Horm Res 2003;60(suppl 2):53–60.
24.
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Clemmons DR: Commercial assays available for insulin-like growth factor-I and their use in diagnosing growth hormone deficiency. Horm Res 2001;55:73–79.
26.
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27.
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28.
Parkinson C, Renehan AG, Ryder WD, O’Dweyer ST, Shalet SM, Trainer PJ: Gender and age influence the relationship between serum GH and IGF-I in patients with acromegaly. Clin Endocrinol (Oxf) 2002;57:363–370.
29.
Peacey SR, Toogood AA, Veldhuis JD, Thorner MO, Shalet SM: The relationship between 24 hour GH secretion and IGF-I in patients with successfully treated acromegaly: impact of surgery or radiotherapy. J Clin Endocrinol Metab 2001;86:259–266.
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