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Gigantism is a state of hyperfunction of the anterior pituitary gland and increased secretion of growth hormone, leading to the so-called enormous growth. The ailment develops when hyperactivity appears in adolescence, before the growth of the growth cartilages and the fusion of bone epiphyses.
Gigantism – Definition
Gigantism is an excessive, atypical growth associated with an overactive anterior pituitary gland and excessive secretion of growth hormone. People suffering from gigantism are usually taller than their friends / peers, which attracts attention to themselves. In school age, excessive growth may also be associated with obesity, which makes the excess body fat give the impression that the child is taller and more developed than his peers. Gigantism can be divided into two types – occurring in children and adults. Its development takes place in adolescence, when the growth cartilages have not yet ossified and the epiphyses have fused.
Gigantism, unlike acromegaly, develops when hyperthyroidism occurs before puberty, i.e. in adolescence, i.e. before the period of epiphysis and ossification of growth cartilages. If the increased secretion of growth hormone, which during the development of the organism caused its enormous growth, called gigantism, ceases after puberty, then the enormous growth will not be associated with the features of acromegaly. If it continues, acromegaly may join the enormous growth.
Types of gigantism
1. Pituitary gigantism – it is caused by the excessive secretion of growth hormone by the pituitary adenoma or due to the excessive stimulation of the pituitary gland by the GHRH hormone. The first symptoms of this type of gigantism include visual disturbances caused by an adenoma pressing on the optic nerve. In the diagnosis of this ailment, determinations of the secretion of growth hormone, magnetic resonance imaging or IGF-I level testing are used.
2. Eunuchoid gigantism – is caused by a lack of sex hormones. Excessive growth is due to delayed ossification of the epiphyseal cartilages (due to the low level of estrogens that affect their mineralization) and manifests itself quite late. Additionally, sexual maturation is delayed. The diagnosis of the disease is based on the medical history of the patient. Then, computed tomography is performed, which allows you to locate the tumor of the pituitary gland, which inhibits the secretion of hormones through pressure. In addition, hormonal tests are performed, which determine the level of estrogen concentration.
3. Species gigantism – it is related to the adaptation of animals to environmental conditions.
The causes of gigantism
Most of the time, too much growth hormone is secreted from a benign pituitary tumor. However, other conditions may also be the cause, such as:
- syndrome McCune-Albrighta,
- Carney’s syndrome,
- neurofibromatosis,
- multiple adenomatosis type 1.
Genetic defects, such as Marfan’s syndrome, are rarely the cause of gigantism. Gigantism is extremely rare in childhood and can also occur during puberty in girls and boys who are hormone deficient.
The frequency of gigantism
Hormonal disorders of the adrenal glands occur in about 1 in 14 newborns. Single cases of pituitary gigantism have been reported in children.
Symptoms of gigantism
Apart from secreting excessively high growth hormone, gigantism also affects children’s internal organs. In adults, there is an enlargement and thickening of bones, connective tissue or cartilage. Moreover, organs can also change their size. In adults, gigantism appears between the ages of 30 and 45. Among other symptoms indicating the disease, we can mention:
- Headache,
- problems with side vision,
- double vision
- delayed puberty
- menstrual disorders (irregular periods),
- excessive sweating
- protruding and clearly defined jaw,
- general weakness
- feet with thick toes,
- big hands,
- thickening of scratches,
- discharge of milk from the breasts.
Recognition of gigantism
The occurrence of the above-mentioned symptoms should be an indication for a visit to a doctor who will help find the cause of the excessive growth. In order to make a correct diagnosis, the following tests are carried out.
1. Testing the level of growth hormone and IGF-1. When the doctor determines the features of early puberty, the adrenal hormones 17-hydroxyprogesterone, androstenedione and testosterone should be tested, as well as an X-ray of the wrist and hand to determine the stage of maturation in the skeleton.
2. Computed tomography or magnetic resonance imaging – help to detect a pituitary tumor.
3. Testing the level of prolactin in the blood (high levels suggest gigantism).
4. Testing insulin-like growth factor (high levels may indicate gigantism).
5. Sometimes it is necessary to test the urine from a 24-hour collection.
6. Cardiological and ophthalmological consultation – when Marfan syndrome is suspected (joint flexibility, disproportionately long hands and feet).
7. Determination of pituitary hormones LH and GSH as well as sex hormones: testosterone and estradiol (if after the age of 14 in children with long limbs in relation to the body, there are no signs of maturation).
8. Examination of sex chromosomes.
The diagnosis of gigantism in children consists in comparing the child’s height with the norms for a given age and gender on the so-called percentile grids. If the normal norms and growth rate are maintained, the doctor usually does not recommend further tests. On the other hand, when the doctor notices disturbing symptoms, such as disproportionate body build or too early maturation, he or she will refer the child to an endocrinologist.
Gigantism – treatment
In the treatment of gigantism, an operation is often performed, which is indicated when the pituitary tumor has clearly marked edges. Many patients who underwent the procedure see the desired results. However, there are situations when a specialist is unable to excise the tumor, and then another method of therapy is chosen. The most effective method is somatostatin, which reduces the amount of growth hormone produced. In addition, dopamine agonists are used, but this type of treatment is less effective.
Occasionally, radiation therapy is needed to restore the correct amount of growth hormone. However, the effects of this type of treatment don’t show up until five or ten years later. This method is used when medications and surgery do not bring any improvement.
What after treatment?
After completing the treatment, girls should undergo ultrasound of the uterus and ovaries once a year, and consult a gynecologist. It is also important to check with an endocrinologist (at least twice a year).
Is it possible to recover completely?
Treatment of suppression of growth is continued until final height is achieved. At the end of therapy, the specialist takes a picture of the hand and knee joint to confirm that growth is complete. However, it is worth remembering that disorders in the secretion of adrenal hormones usually require treatment for the rest of your life. On the other hand, the deficiencies of sex hormones are replenished until the menopausal age is reached.
Read also: Pituitary gland