Pituitary Gigantism

Pituitary gigantism is a rare medical condition characterized by an excessive production of growth hormone (GH) due to a benign tumor on the pituitary gland, leading to abnormal and accelerated growth.

Causes

The primary cause of pituitary gigantism is a non-cancerous tumor on the pituitary gland, known as an adenoma. This tumor secretes excess GH, which stimulates the production of insulin-like growth factor 1 (IGF-1) in the liver and other tissues. The elevated levels of IGF-1 promote excessive growth and development.

Symptoms

The symptoms of pituitary gigantism can vary depending on the age of onset and the severity of the condition. Common symptoms include:

• Excessive height, often above 6 feet 2 inches (188 cm) in adults
• Enlarged hands and feet
• Coarsening of facial features, such as a prominent jaw and nose
• Joint pain and limited mobility due to excessive growth
• Headaches and visual disturbances due to the tumor's pressure on surrounding tissues
• Sleep apnea and other respiratory problems
• Carpal tunnel syndrome and other nerve compression disorders
• Excessive sweating and oiliness of the skin
• Acne and other skin problems

Diagnosis

The diagnosis of pituitary gigantism typically involves a combination of physical examination, medical history, laboratory tests, and imaging studies. The following tests may be used to diagnose the condition:

• Blood tests to measure GH and IGF-1 levels
• Imaging studies, such as MRI or CT scans, to visualize the pituitary gland and detect any tumors
• Physical examination to assess growth patterns and look for signs of excessive GH production

Treatment

The primary goal of treatment for pituitary gigantism is to reduce GH production and alleviate symptoms. Treatment options may include:

• Surgical removal of the tumor, either through transsphenoidal surgery or craniotomy
• Medications that inhibit GH production, such as somatostatin analogs (e.g., octreotide) or dopamine agonists (e.g., bromocriptine)
• Pegvisomant, a medication that blocks the action of GH at the receptor level
• Radiation therapy to shrink the tumor and reduce GH production

Prognosis

The prognosis for individuals with pituitary gigantism depends on the effectiveness of treatment and the presence of any complications. With prompt and proper treatment, it is possible to control the condition and prevent further growth. However, if left untreated, pituitary gigantism can lead to serious health problems, including:

• Cardiovascular disease
• Respiratory problems
• Joint damage and limited mobility
• Cognitive impairment and mental health issues

Epidemiology

Pituitary gigantism is a rare condition, affecting approximately 3-4 people per million. It can occur at any age, but it typically affects children and adolescents during periods of rapid growth.