title: Pegvisomant therapy in pituitary gigantism: successful treatment in a 12-year-old girl.
abstract: OBJECTIVE
  The use of a growth hormone (GH) receptor antagonist, pegvisomant has shown great promise in adults with acromegaly, but experience in paediatric patients is lacking. We aimed to describe the results of pegvisomant therapy in a 12-year-old girl with an aggressive GH-secreting pituitary tumour.
  
  
  METHODS
  To evaluate the ability of pegvisomant therapy to control the effects of peripheral GH excess in a case of pituitary gigantism.
  
  
  METHODS
  Pegvisomant was introduced at 10 mg/day, given subcutaneously, and gradually increased to 20 mg/day until serum IGF-I was normal for age.
  
  
  RESULTS
  A large pituitary adenoma with suprasellar extension was diagnosed in a 12-year-old girl with progressive tall stature (178 cm), GH hypersecretion without suppression during oral glucose loading (nadir serum GH, 90 mU/l), high serum IGF-I and serum prolactin levels. Surgical extirpation was not possible because tumour tissue was fibrous and adherent to the optical nerves. Histological examination showed a mixed GH- and prolactin-secreting adenoma with lymphocytic infiltration of B and T cells. Treatment with a dopamine agonist, cabergoline, normalized serum prolactin, but GH secretion was resistant to both somatostatin analogue, octreotide and cabergoline. Radiation followed by pegvisomant therapy titrated up in dose to 20 mg/day led to a marked reduction in GH secretion and normalization of IGF-I, and to growth arrest and improvement of well-being.
  
  
  CONCLUSIONS
  We suggest that treatment in pituitary gigantism with pegvisomant is safe and may normalize IGF-I levels and effectively stop growing.
authors.affiliation: Department of Paediatrics, Aalborg University Hospital, Denmark. mariane.rix@dadlnet.dk
authors.forename: M
authors.initials: M
authors.lastname: Rix
authors.forename: P
authors.initials: P
authors.lastname: Laurberg
authors.forename: A S
authors.initials: AS
authors.lastname: Hoejberg
authors.forename: B
authors.initials: B
authors.lastname: Brock-Jacobsen
mesh_terms: D000236:Adenoma / Q000188:drug therapy* / Q000473:pathology; D001827:Body Height; D002648:Child; D005260:Female; D005877:Gigantism / Q000188:drug therapy* / Q000473:pathology; D019382:Human Growth Hormone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008279:Magnetic Resonance Imaging; D010911:Pituitary Neoplasms / Q000188:drug therapy* / Q000473:pathology; D011986:Receptors, Somatotropin / Q000037:antagonists & inhibitors
chemical_list: D011986:Receptors, Somatotropin; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I; C406545:pegvisomant