New developments in the management of acromegaly. Should we achieve absolute biochemical cure?

Introduction Acromegaly is an uncommon condition with a prevalence in European populations of about 40 per million, and an incidence of four to six new cases per million population per year. The vast majority (99%) of cases of acromegaly are due to a pituitary somatotrophinoma, the occasional rare case being caused by ectopic production of growth hormone-releasing hormone by bronchial carcinoid, pancreatic neuroendocrine, or hypothalamic tumours, giving rise to somatotroph hyperplasia. The onset of the condition is most often very insidious, especially so in the older patient; photographs may reveal evidence of acral expansion 5–10 years before biochemical confirmation of the diagnosis. This long exposure of tissues to excessive secretion of growth hormone (GH) before treatment may be significant with respect to the long-term mortality outcome. Furthermore, it may also explain why about 60–70% of somatotrophinomas are macroadenomas (>1 cm in diameter) at diagnosis, and only a minority (30–40%) are