Gigantism



Gigantism starts in childhood and is usually quite apparent by the age of 10 years. Acromegaly develops in adulthood, becoming apparent usually in the third decade. It is slightly more common in women.

Gigantism Symptoms

Gigantism is caused by a growth in the pituitary gland, causing a massive overproduction of the body growth. The bones simply keep on growing, and the epiphyseal plates, the growing points that normally close, fail to do so.



Excessive secretion of growth hormone in the prepubertal period produces excessive growth—chiefly of the long bones. Parallel with this is greatly increased muscular development, which makes the patient appear strong and well-proportioned physically. There may be features of sexual precocity, which may suggest the underlying abnormality. Later on, the features of acromegaly may set in as well. Associated with these may be indications of involvement of certain nerves, most likely the optic ones. This may suggest the nature of the basic lesion probably a growing tumor in or near the pituitary.

Acromegaly may come on insidiously, and close relatives may be unaware of the slowly developing alterations until they have become well-established. The face tends to become elongated, with coarse features. The skin and underlying tissues become coarse and thick: the facial features, lips, tongue and nose enlarged. The lower jaw typically becomes prominent, and the teeth are often separated as the jaw grows. The sinuses (spaces in the bones) in the frontal region (above and between the eyes) tend to become large and cause prominence of the brows.



The hands may enlarge, and some patients may find it necessary to alter the size of the wedding ring quite frequently in order to make it fit. The feet also continually enlarge, necessitating constant need for new, larger shoe fittings. As the voice box hypertrophies, the voice tends to become deep and husky. Excessive sweating is common.

Often there are odd feelings in the extremities, such as tingling or numb sensations. Carpal tunnel syndrome is common (this also produces tingling fingers due to pressure of the nerve in the wrist as it traverses a cartilage tunnel). The thyroid gland in the neck may enlarge. The ability to concentrate is often impaired. Overweight rarely occurs, but diabetes mellitus (sugar diabetes) develops in about 30 per cent, producing intense thirst, and the desire to void often. Frequently these are the first signs. It is more common if there is a family history of this disorder. All internal organs increase in size, especially the heart (often enlarging to two to three times its normal size), and at a later stage it frequently fails and is often the cause of premature death. In women there is often a reduced sexual drive, with reduction or total cessation of normal menstruation. In males libido wanes and erectile capacity reduces to the level of impotence in many cases.



If there is a pituitary tumor causing the overproduction of hormone, then added symptoms arising from this may also be present. This could include headaches or defects in the visual fields, as already described.

Diagnosis is often made on appearances alone. However, X-rays or CT scans may show bony changes, including alteration in the pattern of the skull in the area of the pituitary gland indicating the probable presence of a tumor.



Specific diagnosis is now possible by the use of radioimmunoassay that can measure accurately the serum level of human growth hormone (HGH).

Excessive production of growth hormone by the anterior pituitary gland may give rise to excessive growth rates. If this occurs during childhood, a condition called gigantism may follow. If it occurs after the normal growing period has finished, a condition called acromegaly may take place.



On the other hand if there is deficient production of the hormone during the childhood growing time, the reverse situation occurs, and inadequate stature, called dwarfism, may result. These conditions will now be considered.

Gigantism Treatment

It depends on the exact cause. Surgery may be required. In recent years a drug called bromocriptine has been used with considerable success in this disorder. Once more this will be organized at a major hospital.

Diagnosis and treatment is in the domain of the specialized endocrine clinic usually found as part of a major hospital. Most large cities are equipped with these centers and are available for diagnosis and treatment.

Many forms of therapy have been used. When visual defects are present, this calls for prompt, active measures. Treatment of the pituitary tumor by surgery or irradiation may be carried out. Several types of therapy are now available, and they seem to give relatively good results. Radioactive yttrium is often used. The steroid medroxyprogesterone has been reported recently as giving satisfactory results. A relatively recent medication called bromoeriptine may be the upcoming star for treatment.



It depends on the exact cause. Surgery may be required. In recent years a drug called bromocriptine has been used with considerable success in this disorder. Once more this will be organized at a major hospital.

Indeed, it is now well-established in the treatment of prolactin excesses and the symptoms attributed to this.