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Growth hormone excess produces gigantism if it happens in childhood.
Suspect when manifestations characteristic of gigantism are present.
These include inappropriate excessive growth spurt, increased hand and foot
size, dorsal kyphosis, manifestations of generalized osteoporosis, thickening
of skin and soft tissue growth. If this is accompanied with CNS pressure
manifestations it suggests a pituitary tumor.
Once suspected diagnostic investigations include glucose tolerance test
and insulin-like growth factor-1 (IGF-1, somatomedin C) assays.
1. Glucose tolerance test: Normally growth hormone is suppressed after
oral intake of 50mg of glucose due to inhibition of GHRH secretion. In cases
of gigantism growth hormone levels fail to suppress or may even rise.
2. insulin-like growth factor-1 (IGF-1, somatomedin C) assays are
always elevated in gigantism and do not fluctuate like growth hormone levels.
Treatment is mainly surgical (transfenoidal adenectomy or hypophysectomy
of the acidophil adenoma is the treatment of choice.
Bromocriptine paradoxically leads to a significant reduction in growth
hormone levels. Cabergonline is another dopaminergic agent used to reduce
growth hormone levels in gigantism.
Octreotide is a synthetic somatostatin analogue which is more effective
External radiotherapy is an option in treating acidophil adenomas.
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