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Acromegaly: Suspect-and-test checklist for clinicians

A one-page worksheet that turns the full Acromegaly diagnosis guide into something you can use at the point of care: what to look for, what to order, which results should not end the workup, and who else to test or refer.

Who it is forClinicians and care teams who may see Acromegaly before it is diagnosed, including primary care, the specialists named in the guide, and referral or genetics coordinators.
When to use itWhen Acromegaly is on the differential, when a patient has several red flags, or when you are preparing a referral or a second opinion.

How to use it, section by section

  1. Red flags present: Tick each finding the patient has. They are grouped by body system so you can scan quickly.
  2. Already labeled as: Tick earlier diagnoses on the chart that the sources say are often given first.
  3. Family to test: Note relatives who may need testing, and record when symptoms began and which specialists have already been seen.
  4. Testing, in order: Tick each test as you order it and write the result on its line. The order follows the published sources.
  5. Results that do not rule it out: A reminder of findings that can look reassuring but do not exclude Acromegaly.
  6. Specialists: Tick the referral, then write who it went to and any notes.
Two ways to fill it inPrint it blank and write on it, or tick boxes and type on this screen first, then print or save as a PDF. Keep it with the chart or send it with the referral.
PrivacyNothing you type is sent or saved. It stays in this browser tab and disappears when you close it. Use patient initials, not full identifiers.

What it is not: Not a diagnostic score, a protocol or coding advice. It summarizes published sources, and clinical judgment and the treating clinician govern. Every point is sourced in the full Acromegaly guide.

One Letter page. Use your browser's print or save as PDF.Full guide with sources
Suspect-and-test checklist
Acromegaly

Over 95% come from a GH-secreting pituitary adenoma. Diagnosis is often delayed 5 to 10 years or more.

ICD-10-CME22.0Trial Friend for Clinicians

1Red flags present

Face, hands and mouth

Symptoms

Associated conditions

Pituitary and young patients

2Already labeled as

3Family to test

4Testing, in the order the sources describe

  1. Serum IGF-1, age-adjustedFirst test. A normal IGF-1 effectively excludes acromegaly. Know the assay.
    Result
  2. IGF-I over 1.3 times ULNWith typical signs, confirms the diagnosis per the 2024 consensus.
    Result
  3. OGTT with GH nadirRaised or equivocal IGF-1. GH not suppressed below 1μg/L confirms; check glucose.
    Result
  4. Pituitary MRI with gadoliniumAfter the biochemical diagnosis; 2 to 3mm slices. CT only if MRI is not possible.
    Result
  5. Visual fields and pituitary functionFields if the tumor abuts the chiasm; assess for hypopituitarism.
    Result
  6. AIP testing in young or familial casesTumor before 18, macroadenoma before 30, or familial pituitary tumors.
    Result
  7. GHRH and body imagingRare ectopic disease, when MRI shows no adenoma.
    Result

5Results the sources say do not rule it out

  • A random GH alone. Secretion is episodic; do not rely on it for diagnosis.
  • IGF-1 read without assay-specific age ranges. Single samples in 23 laboratories missed 30% of cases.
  • Normal or low IGF-1 with oral estrogen, liver or kidney failure, malnutrition or poorly controlled diabetes.
  • Raised IGF-1 with normal GH. It may reflect earlier disease; read it with the clinical picture.

6Specialists the sources name

Diagnosis code: E22.0 Acromegaly and pituitary gigantismCodes patients often carry before diagnosis are listed in the online guide.
Full guide and sourcesEvery point here is sourced in the online guide, which also has a patient note to print.
Trial Friend, trialfriend.com/for-clinicians. Key sources: Endocrine Society guideline (2014); 2024 Acromegaly Consensus Group; Pituitary Society update (2020); Liège Acromegaly Survey (2017); 2023 systematic review; Swedish diagnostic delay study (2020); all 13 with links in the online guide. Checked November 10, 2026. A reference checklist for licensed clinicians that summarizes published sources. It is not a diagnostic tool, a score or a protocol, and it does not replace clinical judgment, local practice or the prescribing information. Not coding advice. Trial Friend never receives anything written or typed on this sheet.