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Acromegaly — IGF‑1 → OGTT → MRI → Surgery

Coarse features, headaches, sleep apnea, diabetes. Confirm biochemically, localize, and treat with surgery first when feasible.

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Transsphenoidal surgery first‑line

Confirm with GH suppression test (OGTT)

Screen with IGF‑1 (age‑adjusted)

Pituitary MRI to localize adenoma

Adjunct medical therapy (SSA, pegvisomant, DA) ± radiation if residual

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