Subclinical Acromegaly: to Treat or Not to Treat?

Abstract Objective Patients with acromegaly usually present with the classical signs of acromegaly, whereas patients without the specific signs or symptoms are rarely diagnosed. This unique entity can be named "subclinical acromegaly". Methods This was a retrospective study. Our study group consisted of 8 patients (6 females) with incidentally diagnosed acromegaly, most following head MRI for unrelated reasons and without the specific signs of acromegaly. Results Mean age at diagnosis was 50.1 ± 16.3 years. Baseline IGF-1 ranged between 1.27–2.08 x upper limit of normal (ULN). MRI depicted a pituitary microadenoma in 6 patients, one patient presented with an intrasellar macroadenoma and one had no visible pituitary mass. Mean calculated SAGIT clinical score was 4.6. Three patients underwent trans-sphenoidal resection; two achieved hormonal remission and one improved but did not normalize IGF-1 following surgery. Five patients (including one following surgery) were given somatostatin analogs, and three normalized IGF-1. Several patients improved clinically following treatment, reporting improvement in snoring, hypertension, or weight loss, and pituitary adenoma decreased in size in 2 patients that responded to medical treatment. Conclusions we report a series of 8 patients with very mild and subclinical acromegaly. It is uncertain whether all such patients will gain clinical benefit from treatment, but some experienced clinical improvement due to treatment.