Gigantism
Overview
Gigantism is abnormally large growth due to an excess of growth hormone during childhood, before the bone growth plates have closed.
Symptoms
* Delayed puberty * Double vision or difficulty with side (peripheral) vision * Frontal bossing and a prominent jaw * Headache * Increased sweating * Irregular periods (menstruation) * Large hands and feet with thick fingers and toes * Release of breast milk * Thickening of the facial features * Weakness
Causes
The most common cause of too much growth hormone release is a noncancerous (benign) tumor of the pituitary gland. Other causes include: * Carney complex * McCune-Albright syndrome (MAS) * Multiple endocrine neoplasia type 1 (MEN-1) * Neurofibromatosis If excess growth hormone occurs after normal bone growth has stopped, the condition is known as acromegaly. Gigantism is very rare.
Prognosis
Pituitary surgery is usually successful in limiting growth hormone production.
Treatment
In pituitary tumors with well-defined borders, surgery is the treatment of choice and can cure many cases. For situations in which surgery cannot completely remove the tumor, medication is the treatment of choice. The most effective medications are somatostatin analogs (such as octreotide or long-acting lanreotide), which reduce growth hormone release. Dopamine agonists (bromocriptine mesylate, cabergoline) have also been used to reduce growth hormone secretion, but these are generally less effective. A medication that blocks the effect of growth hormone, pegvisomant, has recently become available. Radiation therapy has also been used to bring growth hormone levels to normal. However, it can take 5 - 10 years for the full effects to be seen and almost always leads to low levels of other pituitary hormones. Radiation has also been associated with learning disabilities, obesity, and emotional changes in children. Most experts will use radiation only if surgery and medication fail.