title: Pituitary gigantism: a retrospective case series.
abstract: BACKGROUND
  Pituitary gigantism (PG) is a rare pediatric disease with poorly defined long-term outcomes. Our aim is to describe the longitudinal clinical course in PG patients using a single-center, retrospective cohort study.
  
  
  METHODS
  Patients younger than 19 years diagnosed with PG were identified. Thirteen cases were confirmed based on histopathology of a GH secreting adenoma or hyperplasia and a height >2 SD for age and gender. Laboratory studies, initial pathology, and imaging were abstracted.
  
  
  RESULTS
  Average age at diagnosis was 13 years with an average initial tumor size of 7.4×3.8 mm. Initial transsphenoidal surgery was curative in 3/12 patients. Four of the nine patients who failed the initial surgery required a repeat procedure. Octreotide successfully normalized GH levels in 1/6 patients with disease refractory to surgery (1/6). Two out of five patients received pegvisomant after failing octreotide but only one patient responded to treatment. Five patients were ultimately treated with radiosurgery or radiation patients were followed for an average of 10 years.
  
  
  CONCLUSIONS
  PG is difficult to treat. In most patients, the initial transsphenoidal surgery failed to normalize GH levels. If the initial surgery was unsuccessful, repeat surgery was unlikely to control GH secretion. Treatment with octreotide or pegvisomant was successful in less than half the patients failing surgery. Radiosurgery was curative, but is not an optimal treatment for pediatric patients. Despite the small sample, our study suggests that the treatment outcome of pediatric PG may be different than adults.
authors.forename: Ana L
authors.initials: AL
authors.lastname: Creo
authors.forename: Aida N
authors.initials: AN
authors.lastname: Lteif
mesh_terms: D000236:Adenoma / Q000097:blood / Q000188:drug therapy / Q000473:pathology*; D000293:Adolescent; D000328:Adult; D001827:Body Height; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005877:Gigantism / Q000097:blood / Q000188:drug therapy / Q000473:pathology*; D019382:Human Growth Hormone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008137:Longitudinal Studies; D008297:Male; D010911:Pituitary Neoplasms / Q000097:blood / Q000188:drug therapy / Q000473:pathology*; D011379:Prognosis; D011986:Receptors, Somatotropin / Q000037:antagonists & inhibitors; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D011986:Receptors, Somatotropin; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I; C406545:pegvisomant