title: Treatment of pituitary gigantism with the growth hormone receptor antagonist pegvisomant.
abstract: BACKGROUND
  Treatment of pituitary gigantism is complex and the results are usually unsatisfactory.
  
  
  OBJECTIVE
  The objective of the study was to describe the results of therapy of three children with pituitary gigantism by a GH receptor antagonist, pegvisomant.
  
  
  METHODS
  This was a descriptive case series of up to 3.5 yr duration.
  
  
  METHODS
  The study was conducted at a university hospital.
  
  
  METHODS
  Patients included three children (one female, two males) with pituitary gigantism whose GH hypersecretion was incompletely controlled by surgery, somatostatin analog, and dopamine agonist.
  
  
  METHODS
  The intervention was administration of pegvisomant.
  
  
  METHODS
  Plasma IGF-I and growth velocity were measured.
  
  
  RESULTS
  In all three children, pegvisomant rapidly decreased plasma IGF-I concentrations. Growth velocity declined to subnormal or normal values. Statural growth fell into lower growth percentiles and acromegalic features resolved. Pituitary tumor size did not change in two children but increased in one boy despite concomitant therapy with a somatostatin analog.
  
  
  CONCLUSIONS
  Pegvisomant may be an effective modality for the therapy of pituitary gigantism in children. Titration of the dose is necessary for optimal efficacy, and regular surveillance of tumor size is mandatory.
authors.affiliation: University of Michigan Medical Center, Division of MEND, Department of Internal Medicine, Ann Arbor, Michigan 48109, USA.
authors.forename: Naila
authors.initials: N
authors.lastname: Goldenberg
authors.forename: Michael S
authors.initials: MS
authors.lastname: Racine
authors.forename: Pamela
authors.initials: P
authors.lastname: Thomas
authors.forename: Bernard
authors.initials: B
authors.lastname: Degnan
authors.forename: William
authors.initials: W
authors.lastname: Chandler
authors.forename: Ariel
authors.initials: A
authors.lastname: Barkan
mesh_terms: D000293:Adolescent; D000365:Age Determination by Skeleton; D002648:Child; D005260:Female; D005877:Gigantism / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D006128:Growth; D019382:Human Growth Hormone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008297:Male; D010911:Pituitary Neoplasms / 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