eMedicine Specialties > Pediatrics: General Medicine > Endocrinology

Gigantism and Acromegaly: Follow-up

Author: Robert J Ferry Jr, MD, Chief, Division of Pediatric Endocrinology and Diabetes, Le Bonheur Children's Medical Center, University of Tennessee Health Science Center at Memphis and St Jude Children's Research Hospital; Lieutenant Colonel (Medical Corps), 162nd Area Support Medical Company, Army National Guard
Coauthor(s): Melanie Shim, MD, Clinical Instructor, Department of Pediatrics, Division of Pediatric Endocrinology, University of California at Los Angeles School of Medicine
Contributor Information and Disclosures

Updated: Jul 1, 2008

Follow-up

Further Outpatient Care

  • Evaluate long-term efficacy of surgery and radiotherapy by using anatomic tools, including MRI and visual-field evaluation.
  • After surgery and after the start of medical treatment, perform biochemical assessment at 6-12 weeks; normalization of IGF-I levels may occur several months later.
  • All patients with a history of GH excess require periodic life-long evaluation.
  • In one series, the long-term recurrence rate for GH-secreting adenomas in children was 13.3% after surgery.1

Complications

  • Hypopituitarism may develop as the result of the pituitary mass or as a complication of surgery or radiation therapy.
  • Treat pituitary failure with appropriate hormone-replacement therapy.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to recognize and treat coexisting hyperprolactinemia
  • Failure to diagnose associated conditions, such as cardiovascular disease, tumors (eg, colon polyps, benign prostatic hypertrophy), and diabetes
  • Failure to monitor for and detect tumoral recurrence after surgical treatment
 


More on Gigantism and Acromegaly

Overview: Gigantism and Acromegaly
Differential Diagnoses & Workup: Gigantism and Acromegaly
Treatment & Medication: Gigantism and Acromegaly
Follow-up: Gigantism and Acromegaly
Multimedia: Gigantism and Acromegaly
References
[ CLOSE WINDOW ]

References

  1. Abe T, Tara LA, Ludecke DK. Growth hormone-secreting pituitary adenomas in childhood and adolescence: features and results of transnasal surgery. Neurosurgery. Jul 1999;45(1):1-10. [Medline].

  2. Ali O, Banerjee S, Kelly DF, Lee PD. Management of type 2 diabetes mellitus associated with pituitary gigantism. Pituitary. 2007;10(4):359-64. [Medline].

  3. Barkan AL, Burman P, Clemmons DR, et al. Glucose homeostasis and safety in patients with acromegaly converted from long-acting octreotide to pegvisomant. J Clin Endocrinol Metab. 2005;90:5684-5691. [Medline].

  4. Bera TK, Liu XF, Yamada M, Gavrilova O, Mezey E, Tessarollo L, et al. A model for obesity and gigantism due to disruption of the Ankrd26 gene. Proc Natl Acad Sci U S A. 2008;105(1):270-5. [Medline].

  5. Bonapart IE, van Domburg R, ten Have SM, et al. The 'bio-assay' quality of life might be a better marker of disease activity in acromegalic patients than serum total IGF-I concentrations. Eur J Endocrinol. 2005;152:217-224. [Medline].

  6. Cazabat L, Libe R, Perlemoine K, et al. Germline inactivating mutations of the aryl hydrocarbon receptor-interacting protein gene in a large cohort of sporadic acromegaly: mutations are found in a subset of young patients with macroadenomas. Eur J Endocrinol. Jul 2007;157(1):1-8. [Medline].

  7. Clemmons DR, Chihara K, Freda PU, et al. Optimizing control of acromegaly: integrating a growth hormone receptor antagonist into the treatment algorithm. J Clin Endocrinol Metab. Oct 2003;88(10):4759-67. [Medline].

  8. Cozzi R, Attanasio R, Barausse M, et al. Cabergoline in acromegaly: a renewed role for dopamine agonist treatment?. Eur J Endocrinol. Nov 1998;139(5):516-21. [Medline].

  9. Davoodi J, Kelly J, Gendron NH, MacKenzie AE. The Simpson-Golabi-Behmel syndrome causative glypican-3, binds to and inhibits the dipeptidyl peptidase activity of CD26. Proteomics. Jun 2007;7(13):2300-10. [Medline].

  10. Duncan E, Wass JA. Investigation protocol: acromegaly and its investigation. Clin Endocrinol (Oxf). Mar 1999;50(3):285-93. [Medline].

  11. Eugster EA, Pescovitz OH. Gigantism. J Clin Endocrinol Metab. Dec 1999;84(12):4379-84. [Medline].

  12. Ezzat S, Serri O, Chik CL et al. Canadian consensus guidelines for the diagnosis and management of acromegaly. Clin Invest Med. 2006;29:29-39. [Medline].

  13. Fuqua JS, Berkovitz GD. Growth hormone excess in a child with neurofibromatosis type 1 and optic pathway tumor: a patient report. Clin Pediatr (Phila). Dec 1998;37(12):749-52. [Medline].

  14. Gagel RF. Multiple endocrine neoplasia. In: Williams Textbook of Endocrinology. 9th ed. 1627-1649.

  15. Geffner ME, Nagel RA, Dietrich RB, Kaplan SA. Treatment of acromegaly with a somatostatin analog in a patient with McCune-Albright syndrome. J Pediatr. Nov 1987;111(5):740-3. [Medline].

  16. Giustina A, Barkan A, Casanueva FF, et al. Criteria for cure of acromegaly: a consensus statement. J Clin Endocrinol Metab. Feb 2000;85(2):526-9. [Medline].

  17. Herman V, Fagin J, Gonsky R, et al. Clonal origin of pituitary adenomas. J Clin Endocrinol Metab. Dec 1990;71(6):1427-33. [Medline].

  18. Herman-Bonert VS, Zib K, Scarlett JA, Melmed S. Growth hormone receptor antagonist therapy in acromegalic patients resistant to somatostatin analogs. J Clin Endocrinol Metab. Aug 2000;85(8):2958-61. [Medline].

  19. Holl RW, Bucher P, Sorgo W, et al. Suppression of growth hormone by oral glucose in the evaluation of tall stature. Horm Res. 1999;51(1):20-4. [Medline].

  20. Keil MF, Stratakis CA. Pituitary tumors in childhood: update of diagnosis, treatment and molecular genetics. Expert Rev Neurother. Apr 2008;8(4):563-74. [Medline].

  21. Kirschner LS, Carney JA, Pack SD, et al. Mutations of the gene encoding the protein kinase A type I-alpha regulatory subunit in patients with the Carney complex. Nat Genet. Sep 2000;26(1):89-92. [Medline].

  22. Kunwar S, Wilson CB. Pediatric pituitary adenomas. J Clin Endocrinol Metab. Dec 1999;84(12):4385-9. [Medline].

  23. Lissett CA, Peacey SR, Laing I, et al. The outcome of surgery for acromegaly: the need for a specialist pituitary surgeon for all types of growth hormone (GH) secreting adenoma. Clin Endocrinol (Oxf). Nov 1998;49(5):653-7. [Medline].

  24. Malan V, De Blois MC, Prieur M, et al. Sotos syndrome caused by a paracentric inversion disrupting the NSD1 gene. Clin Genet. Jan 2008;73(1):89-91. [Medline].

  25. Melmed S. Medical progress: Acromegaly. N Engl J Med. Dec 14 2006;355(24):2558-73. [Medline].

  26. Melmed S, Casanueva F, Cavagnini F, Chanson P, Frohman LA, Gaillard R, et al. Consensus statement: medical management of acromegaly. Eur J Endocrinol. Dec 2005;153(6):737-40. [Medline].

  27. Melmed S, Casanueva F, Cavagnini F, et al. Consensus statement: medical management of acromegaly. Eur J Endocrinol. 2005;153:737-740. [Medline].

  28. Miyazaki R, Yoshida T, Sakane N, et al. Acromegalic gigantism with low serum level of growth hormone and elevated serum insulin-like growth factor-I. Intern Med. Mar 1995;34(3):183-7. [Medline].

  29. Moran A, Pescovitz OH. Long-term treatment of gigantism with combination octreotide and bromocriptine in a child with McCune-Albright syndrome. Endocr J. 1994;2:111-113.

  30. Mussig K, Gallwitz B, Honegger J, et al. Pegvisomant treatment in gigantism caused by a growth hormone-secreting giant pituitary adenoma. Exp Clin Endocrinol Diabetes. Mar 2007;115(3):198-202. [Medline].

  31. Nanto-Salonen K, Koskinen P, Sonninen P, Toppari J. Suppression of GH secretion in pituitary gigantism by continuous subcutaneous octreotide infusion in a pubertal boy. Acta Paediatr. Jan 1999;88(1):29-33. [Medline].

  32. Orme SM, McNally RJ, Cartwright RA, Belchetz PE. Mortality and cancer incidence in acromegaly: a retrospective cohort study. United Kingdom Acromegaly Study Group. J Clin Endocrinol Metab. Aug 1998;83(8):2730-4. [Medline].

  33. Ray M, Malhi P, Bhalla AK, Singhi PD. Cerebral gigantism with West syndrome. Indian Pediatr. Jul 2003;40(7):673-5. [Medline].

  34. Schmidt H, Kammer B, Grasser M, Enders A, Rost I, Kiess W. Endochondral gigantism: a newly recognized skeletal dysplasia with pre- and postnatal overgrowth and endocrine abnormalities. Am J Med Genet A. Aug 15 2007;143(16):1868-75. [Medline].

  35. Schwartz TH, Stieg PE, Anand VK. Endoscopic transsphenoidal pituitary surgery with intraoperative magnetic resonance imaging. Neurosurgery. 2006;58:44-51. [Medline].

  36. Sotos JF. Overgrowth. Hormonal Causes. Clin Pediatr (Phila). Nov 1996;35(11):579-90. [Medline].

  37. Stratakis CA, Carney JA, Lin JP, et al. Carney complex, a familial multiple neoplasia and lentiginosis syndrome. Analysis of 11 kindreds and linkage to the short arm of chromosome 2. J Clin Invest. Feb 1 1996;97(3):699-705. [Medline].

  38. Thapar K, Kovacs K, Stefaneanu L, et al. Overexpression of the growth-hormone-releasing hormone gene in acromegaly-associated pituitary tumors. An event associated with neoplastic progression and aggressive behavior. Am J Pathol. Sep 1997;151(3):769-84. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

gigantism, acromegaly, growth hormone excess, GH excess, giantism, gigantosoma, giant, hypersomia, somatomegaly, acromegalia, endocrine system, giants, pituitary gland, abnormal growth, multiple endocrine neoplasia type I, MEN type I, McCune-Albright syndrome, MAS, neurofibromatosis, tuberous sclerosis, Carney complex, precocious puberty, café au lait spots, fibrous dysplasia, pituitary hyperplasia, adenoma,

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Robert J Ferry Jr, MD, Chief, Division of Pediatric Endocrinology and Diabetes, Le Bonheur Children's Medical Center, University of Tennessee Health Science Center at Memphis and St Jude Children's Research Hospital; Lieutenant Colonel (Medical Corps), 162nd Area Support Medical Company, Army National Guard
Robert J Ferry Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Diabetes Association, American Medical Association, Endocrine Society, Lawson-Wilkins Pediatric Endocrine Society, Society for Pediatric Research, and Texas Pediatric Society
Disclosure: Nutropin Speakers Bureau Honoraria Speaking and teaching

Coauthor(s)

Melanie Shim, MD, Clinical Instructor, Department of Pediatrics, Division of Pediatric Endocrinology, University of California at Los Angeles School of Medicine
Melanie Shim, MD is a member of the following medical societies: American Diabetes Association and Endocrine Society
Disclosure: Nothing to disclose.

Medical Editor

Phyllis W Speiser, MD, Chief of Pediatric Endocrinology, Schneider Children's Hospital; Professor of Pediatrics, New York University School of Medicine
Phyllis W Speiser, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, Endocrine Society, Lawson-Wilkins Pediatric Endocrine Society, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Barry B Bercu, MD, Professor, Departments of Pediatrics, Molecular Pharmacology and Physiology, University of South Florida College of Medicine, All Children's Hospital
Barry B Bercu, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Clinical Endocrinologists, American Federation for Clinical Research, American Medical Association, American Pediatric Society, Association of Clinical Scientists, Endocrine Society, Florida Medical Association, Lawson-Wilkins Pediatric Endocrine Society, Pituitary Society, Society for Pediatric Research, Society for the Study of Reproduction, and Southern Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Merrily P M Poth, MD, Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences
Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Lawson-Wilkins Pediatric Endocrine Society
Disclosure: Nothing to disclose.

Chief Editor

Stephen Kemp, MD, PhD, Professor, Department of Pediatrics, Section of Pediatric Endocrinology, University of Arkansas and Arkansas Children's Hospital
Stephen Kemp, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Association of Clinical Endocrinologists, American Pediatric Society, Endocrine Society, Phi Beta Kappa, Southern Medical Association, and Southern Society for Pediatric Research
Disclosure: Genentech, Inc. Honoraria Speaking and teaching; Pfiser, Inc. Honoraria Consulting

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.