Monitoring
During the first postoperative year, IGF-1 measurements may be done every 3 to 6 months to confirm remission, then every 6 to 12 months to monitor for recurrence. The comparison of early random GH measurement on days 1 to 14 postsurgery with preoperative GH levels can determine degree of adenoma removal and subsequent long-term remission. OGTT can be added when evaluating patients with borderline IGF-1 levels and signs of disease activity. For patients who did not achieve postoperative remission and those treated with adjuvant SRL, IGF-1 should be assessed 3 months after initiation or dose titration of injectable SRLs and 2 to 4 weeks after initiation or dose titration of oral SRL to establish dosing regimen, then every 6 to 12 months thereafter. For patients on Pegvisomant or Cabergoline, IGF-1 should be measured every 1 to 3 months after initiation or dose titration to establish dosing regimen, then every 6 to 12 months thereafter. Lastly, MRI should be performed at 3 to 6 months postoperatively, if there are signs of biochemical or clinical disease progression, and when change in therapeutic modality is considered (eg prior to repeat surgery or radiotherapy).