Congenital gigantism due to growth hormone-releasing hormone excess and pituitary hyperplasia with adenomatous transformation

Donald Zimmerman, William F. Young, Michael J. Ebersold, Bernd W. Scheithauer, Kalman Kovacs, Eva Horvath, Michael D. Whitaker, Norman L. Eberhardt, Thomas R. Downs, Lawrence A. Frohman

Research output: Contribution to journalArticle

69 Scopus citations

Abstract

The cause of gigantism in most patients is a GH-secreting pituitary tumor. In this report, a case of congenital gigantism due to probable central hypersection of GH-releasing hormone (GHRH) is described. Normal at birth (4.4 kg; 53 cm), our 7-yr-old male patient grew progressively thereafter to attain a height of 182 cm and a weight of 99.4 kg at the time of our evaluation. The markedly increased baseline plasma levels of GH (730 μgrams/L) did not suppress during a standard 3-h oral glucose tolerance test, but did increase 54% after iv infusion of GHRH. Baseline plasma levels of insulin-like growth factor-I, PRL, and immunoreactive GHRH were also markedly increased. Computed imaging of the head showed a large, partially cystic sellar and suprasellar mass. Extensive imaging studies did not localize a potential source of GHRH. Preoperative treatment with octreotide and bromocriptine for 4 months resulted in a 25% reduction of suprasellar tissue mass. The pituitary tissue removed at transsphenoidal and transfrontal operations showed massive somatotroph, lactotroph, and mammosomatotroph hyperplasia. Areas of GH- and PRL-secreting cell adenomatous transformation were also evident. No histological or immunohistochemical evidence of a pituitary source of GHRH was found. The peripheral plasma immunoreactive GHRH concentration remained unaffected by pharmacological and surgical interventions. We suspect that a congenital hypothalamic regulatory defect may be responsible for the GHRH excess in this case.

Original languageEnglish (US)
Pages (from-to)216-222
Number of pages7
JournalJournal of Clinical Endocrinology and Metabolism
Volume76
Issue number1
DOIs
StatePublished - Jan 1993

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical

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    Zimmerman, D., Young, W. F., Ebersold, M. J., Scheithauer, B. W., Kovacs, K., Horvath, E., Whitaker, M. D., Eberhardt, N. L., Downs, T. R., & Frohman, L. A. (1993). Congenital gigantism due to growth hormone-releasing hormone excess and pituitary hyperplasia with adenomatous transformation. Journal of Clinical Endocrinology and Metabolism, 76(1), 216-222. https://doi.org/10.1210/jcem.76.1.8421089