How should I monitor a patient with acromegaly after treatment to assess for disease control and potential complications?

Monitoring a patient with acromegaly after treatment involves regular assessment of disease control and surveillance for potential complications.

• Biochemical monitoring: Measure serum insulin-like growth factor 1 (IGF-1) levels periodically to assess disease activity, as IGF-1 is a reliable marker of acromegaly control. Growth hormone (GH) suppression tests may also be used as needed.
• Imaging: Perform periodic pituitary MRI scans to monitor for residual or recurrent pituitary adenoma after surgery or radiotherapy.
• Assessment for hypopituitarism: Since treatment (especially surgery or radiotherapy) can impair pituitary function, regularly evaluate pituitary hormone axes, including thyroid, adrenal, and gonadal function, to detect hypopituitarism early.
• Screen for complications: Monitor for cardiovascular disease, diabetes mellitus, sleep apnea, and arthropathy, which are common complications of acromegaly. This includes regular blood pressure checks, glucose monitoring, and assessment of symptoms related to these conditions.
• Long-term surveillance: Be aware of late effects of treatment such as hypopituitarism and secondary tumours, especially in patients who have received radiotherapy, and provide appropriate referrals (e.g., endocrinology, cardiology, sleep medicine) as needed.

Close collaboration with endocrinology specialists is essential for tailored monitoring and management plans.

References: This approach aligns with NICE recommendations on monitoring endocrine function after pituitary tumour treatment and surveillance for late effects of brain tumour therapies, including hypopituitarism and secondary complications ³.