A boy 18 years of age is brought with progressively increasing height and increase in shoe size. The child also complains of headache and banging onto objects on side frequently for past 4 months. The same has been noticed by the parents. The parents feel that the child should have stopped growing fast by now as his siblings are much shorter than him though they are older. On examination, the child’s height was 187 cm and his two older brothers were 168 and 169 cm each and his midparental height was 165 cm. The child was subjected to a growth hormone suppression test with 75 g glucose and his growth hormone levels at 60 and 120 minutes were respectively 20 ng/mL and 22 ng/mL. His IGF-1 levels were much higher as compared to his age. He was then subjected to a dynamic MRI of pituitary with contrast and it showed a macroadenoma of the pituitary impinging on the optic chiasma.
The child was subjected to a visual field testing which showed bilateral hemianopia. The child is planned for surgery. The postoperative growth hormone levels are found to be 4 ng/mL and IGF-1 continues to be high. Hence, the option of medical therapy is discussed with the parents. In view of the financial constraints the child is planned for dopamine agonist therapy in form of cabergoline 0.5 mg twice a week. The child is subsequently followed up.
What approach is different in children with gigantism?
Medicine
The modality of radiotherapy is not preferred in children with gigantism but other treatment modalities and follow-up remain the same. The patients with gigantism particularly need to be screened for vascular disease including peripheral vascular disease.
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