Gigantism

Subject: Child Health Nursing

Overview

The condition gigantism results in an individual growing taller than usual. A noncancerous tumor on the pituitary gland, which produces an excessive amount of growth hormone, is the cause of this illness, which most frequently affects youngsters. Giant children will develop extraordinarily tall statures, and many may experience delayed puberty. Unfortunately, because gigantism does not produce many symptoms besides high height, recognizing the illness can be challenging for parents. The child's genetic make-up or a growth spurt may be to blame for the family's abnormally tall stature. For a child's health and wellbeing, a gigantism diagnosis should be made as early as possible. Acromegaly is defined as a condition where growth hormone is secreted as a result of noncancerous tumors in the pituitary gland. That tumor produces too much growth hormone, which leads to a variety of symptoms like abnormally tall children, coarse facial features, disproportionately huge hands and feet, thick fingers, and more. All growth metrics are impacted by gigantism, though not always symmetrically. Excess insulin-like growth factor-I (IGF-I) is associated with systemic organ symptoms and gradual aesthetic deformity over time. Tall stature, mild to moderate obesity (common), an excessive growth of the hands and feet with thick fingers and toes, frontal bossing, hyperhidrosis, and other symptoms are examples of gigantism manifestations.

Gigantism

Due to an excess of growth hormone during childhood before the bone growth plates have closed, Gigantism is an unusually big growth. If excess growth hormones occur after normal bone growth has stopped, the condition is known as acromegaly. Gigantism is very rare.

Causes

The most common cause of too much growth hormone release is a noncancerous benign tumor of the pituitary gland. Other causes include:

  • Carney complex
  • McCune- Albright syndrome (MAS)
  • Multiple endocrine neoplasia types 1(MEN-1)
  • Neurofibromatosis

Exams and tests

  • CT or MRI scan of the head showing pituitary tumor
  • Failure to suppress serum growth hormone (GH) levels after an oral glucose challenge (maximum 75g)
  • High prolactin levels
  • Increased insulin growth factor-I (IGF-I) levels

Damage to the pituitary may lead to low levels of other hormones, including:

  • Cortisol
  • Estradiol (girls)
  • Testosterone (boys)
  • Thyroid hormone

Treatment

  • Surgery is the preferred method of treatment and can successfully treat many cases of pituitary tumors with clearly defined borders.
  • Medication is the preferred course of treatment for cases where surgery cannot entirely eliminate the malignancies. Somatostatin analogs (such as octreotide or long-acting lanreotide), which inhibit the production of growth hormone, are the most effective treatments.
  • Growth hormone release has been reduced with dopamine agonists (bromocriptine mesylate, cabergoline), but these are typically less effective.
  • Growth hormone levels have also been restored to normal using radiation therapy. The full consequences, however, may not be felt for five to ten years, and this almost always results in low levels of other pituitary hormones.

Possible complication

  • Delayed puberty

Surgery and radiation can both lead to low levels of other pituitary hormones, which can cause:

  • Adrenal insufficiency
  • Diabetes insipidus (rarely)
  • Hypogonadism
  • Hypothyroidism

 

 
Things to remember
  • As its name implies, gigantism causes the individual to grow taller than average.
  • This condition, which most often affects children, occurs due to a noncancerous tumor on the pituitary gland that creates too much growth hormone. Children with gigantism will grow unusually tall, and many will experience delayed puberty.
  • Early diagnosis of gigantism is important for the child's health and well-being.
     
  • The definition of acromegaly is a disease caused by noncancerous tumors in the pituitary gland that causes secretions of growth hormone.
  • The difference between acromegaly and gigantism is that acromegaly occurs in adults, typically between the ages of 30 and 50.
  • Both acromegaly and gigantism are caused by a typically benign tumor or adenoma in the pituitary gland.
  •  Manifestations of gigantism include the following: tall stature, mild to moderate obesity (common), an exaggerated growth of the hands and feet, with thick fingers and toes, frontal bossing, hyperhidrosis and so on.
Videos for Gigantism
Hyperpituitarism
Questions and Answers

The condition gigantism results in an individual growing taller than usual. A noncancerous tumor on the pituitary gland, which produces an excessive amount of growth hormone, is the cause of this condition, which most frequently affects children. Giant children will develop unusually tall statures, and many will experience delayed puberty.

Acromegaly is defined as a condition where growth hormone is secreted as a result of noncancerous tumors in the pituitary gland. Acromegaly differs from gigantism in that it affects adults, often between the ages of 30 and 50. Growth hormone levels that are elevated can have an impact on a variety of bodily systems, including the cardiovascular and musculoskeletal systems. Acromegaly patients may also see changes in their appearance, such as wider gaps between teeth and enlargements of the hands, feet, and facial features.

Causes:

A generally benign tumor or adenoma in the pituitary gland is the root cause of both acromegaly and gigantism. That tumor produces too much growth hormone, which leads to a variety of symptoms like abnormally tall children, coarse facial features, disproportionately huge hands and feet, thick fingers, and more. However, it is unknown what causes the benign tumor to develop in the first place. What is known is that diseases like diabetes, high blood pressure, and carpal tunnel syndrome exacerbate the conditions.

Signs and symptoms:

Gigantism

All growth metrics are impacted by gigantism, though not always symmetrically. Excess insulin-like growth factor-I (IGF-I) is associated with systemic organ symptoms and gradual aesthetic deformity over time. The following are examples of gigantism manifestations:

  • High stature
  • Moderate to mild obesity (common)
  • Macrocephaly (may precede linear growth) (may precede linear growth)
  • Soft tissue enlargement
  • Disproportionately large hands and feet with big fingers and toes
  • Face with rough features
  • Head-on bossing
  • Prognathism
  • Hyperhidrosis
  • Osteoarthritis (a late characteristic of IGF-I excess) (a late feature of IGF-I excess)
  • Neuropathies of the periphery (eg, carpel tunnel syndrome)
  • If IGF-I excess persists, cardiovascular illness (such as cardiac enlargement, hypertension, and left ventricular hypertrophy) can develop.
  • Harmless tumors (uterine myomas, prostatic hypertrophy, colon polyps, and skin tags, which are frequently found in acromegaly)
  • Endocrinopathies (such as hyperprolactinemia, diabetes, and/or impaired glucose tolerance)

Acromegaly

Signs and symptoms of acromegaly include the following:

  • Skin on the face and extremities that feels squishy (one of the earliest signs in acromegaly is swelling of soles and palms)
  • Thick, strong nails
  • Nasolabial folds and forehead creases getting deeper
  • Apparent big pores
  • Thick, swollen eyelids
  • Nasal and lower lip enlargement (the nose takes on a triangular configuration)
  • Wide tooth spacing and prognathism
  • Cutis vertices gyrata (i.e., scalp gyri-like furrows): Cutis vertices may first show signs of acromegaly.
  • Skin tags, or small sessile and pedunculated fibromas: Skin tags and polypoid lesions have been linked in the literature, but there are currently no conclusive studies to support this association.
  • About 50% of people with acromegaly have hypertrichosis, which is different from virilizing illnesses in that it does not affect the beard region.
  • Greasy skin (acne is not common)
  • Among patients, 40% had hyperpigmentation.
  • Acanthosis nigricans (a rare condition): Occurs when keratinocytes and fibroblasts in the skin are overstimulated.
  • Excessive perspiration, both eccrine and apocrine
  • Atrophic breast tissue and galactorrhea
  • Elevated blood pressure
  • Regurgitation of the mitral valve
  • Slight hirsutism

 

Acromegaly and Gigantism Treatment:

Tumors in the pituitary gland result in excessive growth hormone production in the body, which causes acromegaly and gigantism. Removing the tumor and lowering growth hormone levels are the two main objectives of treatment for gigantism or acromegaly.

Tumor Removal for Treatment of Gigantism and Acromegaly

The best course of action for acromegaly is, if at all possible, tumor excision. The minimally invasive method is transsphenoidal microsurgery. Through the sinus openings, this operation removes or reduces the tumor while also releasing pressure that the tumor creates. According to the tumor's size and location, this surgery has a variable success rate. The cure rate for small tumors ranges from 80 to 85%. The cure rate for larger tumors is between 50 and 60 percent. A craniotomy, or opening of the skull to remove the tumor, may occasionally be necessary as part of the treatment for acromegaly. Only if the tumor cannot be removed via the sinuses is this necessary.

Medication Therapy for Gigantism and Acromegaly

Medication may be used to control hormone production when patients are not ideal surgical candidates or when the doctor is unable to surgically remove the entire tumor. Injections of somatostatin analogs are one possibility. In addition to reducing tumor size in 30 to 50% of patients, these injections also help with other gigantism and acromegaly symptoms such sleep apnea, headaches, and joint discomfort. The target issue may not always be the tumors themselves, but rather the effects of high doses of growth hormone on the body. Without actually affecting the tumor, the drug pegvisomant inhibits the effects of growth hormone on the body. Pegvisomant is an injection, just like somatostatin.

Radiation Therapy as Treatment for Gigantism and Acromegaly

Patients may require radiation therapy if surgery and medicines are ineffective at controlling their symptoms or shrinking their tumors. Through the use of targeted radiation, stereotactic radiosurgery can help shrink tumors and reduce growth hormone levels. The procedure is risky, but modern technology makes sure that the radiation exposure to the nearby brain tissue is kept to a minimum. Radiation therapy is, however, generally avoided in children because it can cause emotional changes, learning disabilities, and obesity.

 

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