title: Pituitary gigantism: a case report.
abstract: OBJECTIVE
  To present a rare case of gigantism.
  
  
  METHODS
  A 25-year-old lady presented with increased statural growth and enlarged body parts noticed since the age of 14 years, primary amenorrhea, and frontal headache for the last 2 years. She has also been suffering from non-inflammatory low back pain with progressive kyphosis and pain in the knees, ankles, and elbows for the last 5 years. There was no history of visual disturbance, vomiting, galactorrhoea, cold intolerance. She had no siblings. Family history was non-contributory. Blood pressure was normal. Height 221 cm, weight 138 kg, body mass index (BMI)28. There was coarsening of facial features along with frontal bossing and prognathism, large hands and feet, and small goitre. Patient had severe kyphosis and osteoarthritis of knees. Confrontation perimetry suggested bitemporal hemianopia. Breast and pubic hair were of Tanner stage 1. Serum insulin like growth factor-1 (IGF1) was 703 ng/ml with all glucose suppressedgrowth hormone (GH)values of >40 ng/ml. Prolactin was 174 ng/ml. Basal serum Lutenising Hormone (LH), follicle stimulating Hormone (FSH) was low. Oral glucose tolerance test (OGTT), liver and renal function tests, basal cortisol and thyroid profile, Calcium, phosphorus and Intact Parathyroid hormone (iPTH) were normal. Computed tomographyscan of brain showed large pituitary macroadenoma. Automated perimetry confirmed bitemporal hemianopia. A diagnosis of gigantism due to GH secreting pituitary macroadenoma with hypogonadotrophichypogonadism was made. Debulking pituitary surgery followed by somatostatin analogue therapy with gonadal steroid replacement had been planned, but the patient refused further treatment.
authors.affiliation: Department of Endocrinology and Metabolism, SSKM and IPGMER, Kolkata, India.
authors.forename: Rana
authors.initials: R
authors.lastname: Bhattacharjee
authors.forename: Ajitesh
authors.initials: A
authors.lastname: Roy
authors.forename: Soumik
authors.initials: S
authors.lastname: Goswami
authors.forename: Chitra
authors.initials: C
authors.lastname: Selvan
authors.forename: Partha P
authors.initials: PP
authors.lastname: Chakraborty
authors.forename: Sujoy
authors.initials: S
authors.lastname: Ghosh
authors.forename: Dibakar
authors.initials: D
authors.lastname: Biswas
authors.forename: Ranen
authors.initials: R
authors.lastname: Dasgupta
authors.forename: Satinath
authors.initials: S
authors.lastname: Mukhopadhyay
authors.forename: Subhankar
authors.initials: S
authors.lastname: Chowdhury
keywords: Pituitary; gigantism
references.citation: N Engl J Med. 1999 Feb 18;340(7):524
references.pmid: 10021473
references.citation: Pituitary. 2009;12(3):236-44
references.pmid: 18683056
references.citation: N Engl J Med. 2011 Jan 6;364(1):43-50
references.pmid: 21208107