Ann Pediatr Endocrinol Metab.  2014 Jun;19(2):96-99. 10.6065/apem.2014.19.2.96.

Gigantism caused by growth hormone secreting pituitary adenoma

• Rhee N
• Jeong K
• Yang EM
• Kim CJ

• KMID: 1803861
• DOI: http://doi.org/10.6065/apem.2014.19.2.96

Abstract

Gigantism indicates excessive secretion of growth hormones (GH) during childhood when open epiphyseal growth plates allow for excessive linear growth. Case one involved a 14.7-year-old boy presented with extreme tall stature. His random serum GH level was 38.4 ng/mL, and failure of GH suppression was noted during an oral glucose tolerance test (OGTT; nadir serum GH, 22.7 ng/mL). Magnetic resonance imaging (MRI) of the brain revealed a 12-mm-sized pituitary adenoma. Transsphenoidal surgery was performed and a pituitary adenoma displaying positive immunohistochemical staining for GH was reported. Pituitary MRI scan was performed 4 months after surgery and showed recurrence/residual tumor. Medical treatment with a long-acting somatostatin analogue for six months was unsuccessful. As a result, secondary surgery was performed. Three months after reoperation, the GH level was 0.2 ng/mL and insulin-like growth factor 1 was 205 ng/mL. Case two involved a 14.9-year-old boy, who was referred to our department for his tall stature. His basal GH level was 9.3 ng/mL, and failure of GH suppression was reported during OGTT (nadir GH, 9.0 ng/mL). Pituitary MRI showed a 6-mm-sized pituitary adenoma. Surgery was done and histopathological examination demonstrated a pituitary adenoma with positive staining for GH. Three months after surgery, the GH level was 0.2 ng/mL and nadir GH during OGTT was less than 0.1 ng/mL. Pituitary MRI scans showed no residual tumor. We present two cases of gigantism caused by a GH-secreting pituitary adenoma with clinical and microscopic findings.

Keyword

Gigantism; Pituitary adenoma; Growth hormone

MeSH Terms

Brain
Gigantism*
Glucose Tolerance Test
Growth Hormone*
Growth Hormone-Secreting Pituitary Adenoma
Growth Plate
Humans
Magnetic Resonance Imaging
Male
Neoplasm, Residual
Pituitary Neoplasms*
Reoperation
Somatostatin
Growth Hormone
Somatostatin

Figure

• 

  Fig. 1 Contrast enhanced T1 weighted brain magnetic resonance imaging revealed a 12-mm-sized isointense mass in the pituitary gland (A). A formalin fixed section (B) was immunostained with antibodies against human growth hormone (GH), prolactin, thyroid stimulating hormone beta-subunit, and glycoprotein hormone alpha-subunit. GH-immunopositive cells were common (Immunostain, ×400).

• 

  Fig. 2 Sagittal T1 weighted brain magnetic resonance imaging revealed an isointense mass (6 mm) on pituitary gland (A). A formalin fixed section (B) was immunostained with antibodies against human growth hormone (GH), prolactin, thyroid stimulating hormone beta-subunit, and glycoprotein hormone alpha-subunit. GH-immunopositive cells were common (Immunostain, ×400).

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