Pituitary Gigantism: A Case Report
This 25-year-old lady,hailing from a rural area of West Bengal, presented to us with history of 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. At the time of presentation, she was unable to walk without assistance. There was no history of visual disturbance, vomiting, galactorrhoea, cold intolerance, acroparaesthesia, overt gastrointestinal bleeding, or snoring. She had no siblings. There was no history of similar illness in the family.\nOn examination, vitals were stable with normal blood pressure. Height was 221 cm; weight was 138 kg with BMI of 28. There was coarsening of facial features along with frontal bossing and prognathism. She had large hands and feet [Figures –]. Her voice was deep. There was a small goitre. Patient could not stand straight due to severe kyphosis and osteoarthritis of knees with limited joint mobility. Osteoarthritic changes were also present in the small joints of the hand. Confrontation perimetry suggested bitemporal hemianopia. There was no visceromegaly. Breast was Tanner stage 1, and there was no axillary or pubic hair.\nLaboratory investigation showed OGTT of 136 mg/dl with normal liver and renal function test. Serum IGF1 was 703 ng/ml with all glucose suppressed GH values of >40 ng/ml. Prolactin was 174 ng/ml. Basal cortisol and thyroid profile were normal. Pooled sera showedFSH of 1.05 and LH of 0.272 mIU/ml. Serum calcium, and phosphorus were normal. iPTH was 16.7 pg/ml. Hemoglobin was 11.1 g/dl. Computed tomographyscan of brain showed large pituitary macroadenoma. Magnetic resonance imaging (MRI) could not be done as the patient could not be negotiated within the MRI machine. Automated perimetry confirmed bitemporal hemianopia. ultrasound (USG) showed small, prepubertaluterine volume (1.5 ml). X-rays showed osteoarthritic changes of spine, knees, and small joints of the hand. Epiphyses were seen to be fused in X-rays of hands and knees.\nA diagnosis of gigantism due to GH secreting pituitary macroadenoma with hypogonadotrophichypogonadism was made. Debulkingpituitary surgery followed by somatostatinanalogue therapy with gonadal steroid replacement had been planned, but the patient refused further treatment.