Figure 1. Treatment algorithm for acromegaly. The GH levels (given in ng/ml) represent postoperative values obtained after an oral glucose tolerance test or a random value obtained after 3 months of sandostatin–LAR treatment. Insulin-like growth factor–I levels should be standardized for age- and sex-specific differences. Cabergoline may be added to other pharmacological therapies at any stage if the levels of GH and IGF-I are not normalized. Short arrow pointing upward indicates elevated; GHa = growth hormone antagonist; Micro = microadenoma; N = normal; SSTA = somatostatin analog therapy; XRT = radiotherapy.