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Case report
Successful treatment of pituitary gigantism
  1. Clara Cunha1,
  2. Catarina Saraiva1,
  3. Conceição Canas Marques2 and
  4. João Sequeira Duarte1
  1. 1Endocrinology, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Egas Moniz, Lisboa, Portugal
  2. 2Serviço de Neurocirurgia, Hospital de Egas Moniz, Lisboa, Portugal
  1. Correspondence to Dr Clara Cunha; cicunha{at}chlo.min-saude.pt

Abstract

Pituitary gigantism is extremely rare, resulting from excessive secretion of growth hormone (GH) before fusion of epiphysial growth plates. We report a case of a 13-year-old boy, who presented with increased statural growth and headaches since the age of 10 years. On physical examination, his height was 180.7 cm (+3.3 SD) and Tanner stage V. Investigation revealed increased levels of serum age-adjusted and sex-adjusted insulin-like growth factor 1 (IGF-1) and failure of GH suppression during an oral glucose tolerance test (OGTT). MRI of the sellar region revealed a pituitary macroadenoma. He underwent transsphenoidal surgery and histopathological evaluation revealed mammosomatotropic adenoma. Three months after surgery, IGF-1 normalised, nadir GH during OGTT was less than 1 ng/mL and no residual tumour was found on the MRI. Genetic testing identified a mutation in the AIP gene. This case emphasises the importance of early diagnosis of gigantism, as treatment delay increases long-term morbidity.

  • pituitary disorders
  • endocrinology

http://dx.doi.org/10.1136/bcr-2021-247989

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    Footnotes

    • Contributors CC drafted the manuscript. CC, CS, CCM and JSD reviewed and edited the manuscript prior to submission. CC, CS, CCM and JSD were the physicians who contributed to the care of the patient. JSD also performed final editing of the manuscript and gave the approval to submit the manuscript for publication.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.