Case Report - Gigantism Diagnosed in a Grown-Up Male

BAOJ Medical and Nursing
BAOJ Med Nursing 003
Vol: 1, Issue: 1
Case Report - Gigantism Diagnosed in a Grown-Up Male
Cheung K K, Ma RC, So W Y, Kong A P, Chow F C.
Departments of Medicine and Therapeutics, The Chinese University of Hong Kong.
Case Report
Gigantism is a rare disorder due to growth hormone (GH) excess
that occurs before fusion of the epiphyseal growth plates, therefore,
this condition is usually only seen in growing children.If the
condition is not recognized before adulthood, a diagnosis could
still be made in a grown-up based on clinical, biochemical, and
histological characteristics.
A 28 yr-old Chinese man, who had recently immigrated to Hong
Kong from Mainland China, presented with a 6-month history of
progressive worsening of vision and headache. He was noted to
A
B
C
D
E
F
have tall stature, large hands and feet, coarsening of facial features
with enlargement of the nose and frontal bossing, and widening of
interdental spaces (figure A-D).
An urgent CT brain showed a pituitary macroadenoma which
was confirmed on a MRI pituitary to be 5x4∙7x5cmin size with
compression onto the optic chiasm (figureE).
Investigations revealed excessive insulin-like-growth-factor-1
650ng/mL (age-specific reference range [RR] 63-373ng/mL),
elevated prolactin 788mIU/l (RR<324mIU/l), secondary
hypothyroidism (free-thyroxine10∙2pmol/l [RR 12∙0-22∙0pmol/l],
thyroid-stimulating-hormone 1∙9mIU/l [RR 0∙27-4∙20mIU/l]),
and secondary hypogonadism (testosterone 0∙7nmol/L [RR
9-34∙7nmol/l], lutenizing-hormone 1∙5IU/l [RR 1∙7-8∙6IU/l],
follicle-stimulating-hormone
1∙8IU/l
[RR1∙5-12∙4IU/l]).
Examination by an ophthalmologist confirmed bitemporal
hemianopia (figureF). The mild elevation of prolactin illustrated the
phenomenon of “pseudoprolactinoma”; an elevation of prolactin
due to mass effect from a pituitary adenoma on the pituitary stalk
resulting in interference of the passage of dopamine, a prolactin
inhibitor, from hypothalamus to the anterior pituitary.
In view of the mass effect, our patient was sent for an emergency
transsphenoidal surgery with excision of the macroadenoma under
hydrocortisone cover. Immunohistology showed positive staining
for GH only. Post-operatively, he was noted to have excessive urine
output while biochemistry results confirmed diabetes insipidus.
Therefore, desmopressin was initiated. Upon discharge, the patient
was on desmopressin, hydrocortisone, and thyroxine. He would
be considered for testosterone replacement at a later stage at his
follow-up.
*Corresponding Author: Cheung K K, Department of Medicine and
Therapeutics, The Chinese University of Hong Kong,Prince of Wales
Hospital, New Territories, Hong Kong, Tel: 852-26323129 Fax: 85226358902; Email: [email protected]
Article Type: Case Report
Sub Date: 4 May, 2015
Acc Date: 14 May, 2015
Pub Date: 19 May, 2015
Clinical photos and radiological image of an adult suffering from
gigantism
(A) Coarsening of facial features with enlargement of the nose and
frontal bossing, and widening of interdental spaces. (B) Tall stature.
(C) Enlarged hands. (D) Enlarged feet. (E) MRI pituitary image
showing pituitarymacroadenoma with optic chiasm compression. (F)
Bitemporal hemianopia on visual confrontation test.
Citation: Cheung K K, Ma RC, So W Y, Kong A P, Chow F C (2015) Case
Report-Gigantism Diagnosed in a Grown-Up Male. BAOJ Med Nursing
003 Vol: 1, Issue: 1.
Copyright: © 2015 Cheung K K, et al. This is an open-access article
distributed under the terms of the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction
in any medium, provided the original author and source are credited.
Citation: Cheung K K, Ma RC, So W Y, Kong A P, Chow F C (2015) Case Report-Gigantism Diagnosed in a Grown-Up Male. BAOJ Med Nursing 003 1
Vol: 1, Issue: 1.