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Acromegaly — RACP Adult Medicine MCQ

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EasyEndocrinology & DiabetesAcromegalyRACP Adult Medicine

A 28-year-old woman is diagnosed with acromegaly. MRI shows a 1.5 cm pituitary macroadenoma. Her IGF-1 is 3 times the upper limit of normal and GH fails to suppress on OGTT. What is the recommended first-line treatment?

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Correct answer: C — Transsphenoidal surgery

Transsphenoidal surgery is the first-line treatment for acromegaly when the tumour is surgically accessible, as it offers the best chance of biochemical remission (particularly for microadenomas and non-invasive macroadenomas – cure rates 70–90% and 40–70% respectively). If surgery is unsuccessful or contraindicated, somatostatin analogues (octreotide, lanreotide) are first-line medical therapy. Pegvisomant (GH receptor antagonist) is used for refractory disease.

Reference: eTG – 2025 – Endocrinology; Endocrine Society – 2014 – Acromegaly Treatment Guidelines