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Growth Hormone Excess and Other Conditions of Overgrowth

  • Vibha Singhal
  • Madhusmita Misra
Chapter

Abstract

Tall stature is characterized by increased height velocity and height greater than 2 SDs than predicted for age and sex. The most common cause of tall stature is familial and should be considered after a detailed history, physical examination, and selected laboratory evaluation has ruled out syndromic and non-syndromic causes of tall stature.

Pituitary gigantism is the most common cause of growth hormone (GH) excess. Besides tall stature, clinical features such as coarse facial features, prognathism, arthralgias, and skeletal deformities may suggest GH excess. IGF-1 levels and the nadir GH level after glucose administration help confirm the diagnosis. Subsequent radiologic investigations and visual field testing can provide the location, size, and invasiveness of the GH-secreting somatotroph tumor and help plan further management. Surgery is the first line of therapy. However, multimodal therapy (surgical, medical, and radiologic) may be necessary to control tumor size and GH excess. Somatostatin analogs are used when surgery is not successful in removing the entire tumor and sometimes preoperatively to reduce tumor size and decrease IGF-1 levels, which may improve surgical outcomes. Dopamine agonists and the growth hormone receptor blocker (pegvisomant) are other options available for medical therapy. Radiation therapy may be necessary to control tumor size and IGF-1 levels if surgery and medical therapy are not effective.

Long-term complications related to GH excess and treatment should be monitored and adequately addressed. Glucose intolerance, hypertension, sleep apnea, cardiovascular complications, and vertebral fractures can be seen in patients with prolonged GH excess.

Keywords

Tall stature Overgrowth syndromes Estrogen treatment Epiphysiodesis Pituitary gigantism Transsphenoidal surgery Somatostatin analogs Dopamine agonists Pegvisomant Radiation 

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Pediatric Endocrinology and NeuroendocrinologyMassachusetts General Hospital, Harvard Medical SchoolBostonUSA
  2. 2.Pediatric EndocrinologyMassachusetts General Hospital for ChildrenBostonUSA

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