Gigantism

• II. GIGANTISM

  ● Gigantism is the hypersecretion or overproduction of the growth hormone.

  ● Like Dwarfism, they have the same possible causes but the most common is usually related to a benign tumor of anterior pituitary, probably adenoma
• ASSESSMENT

  1. If overproduction occurs before bone epiphyseal lines close, excessive growth results. Weight increases too but is proportional to height. This becomes evident at puberty.

  2. Acromegaly, the enlargement of the bones of the head, hands, and feet becomes more pronounced after bone epiphyseal lines close when linear growth is no longer possible

  ● It occurs later in life.
• MANAGEMENT

  If untreated, a child may reach a height of more than 8 ft. So, management is important.

  1. If cause is tumor, laser surgery or cryosurgery to freeze tissue is the primary treatment.

  ● Since, tumor is the most common cause in gigantism, its removal will stop compression of the pituitary gland causing excess growth hormone secretion.

  2. If no tumor, irradiation or radioactive implants of the pituitary may reduce excess GH production.

  ● This is internal radiation which also makes the child radioactive. This requires isolation during hospitalization.
• 3. A GH antagonist such as pegvisomant (Somavert) may be prescribed, but other pituitary hormones may be affected

  so can give thyroid extract, cortisol, and gonadotropin

  hormones in later life.

  ● That is why this is only given if radiation or surgery is

  unsuccessful.
• 4. Bromocriptine (Parlodel) taken orally or octreotide

  (Sandostatin), taken by injection, can also reduce GH

  production.

  ● Bromocriptine is a dopamine receptor agonist while

  octreotide mimics somatostatin

  5. Address emotional concerns too.

  ● It is difficult for a child to always be bigger and taller

  than the playmates and this may be distracting for

  them