PT  - JOURNAL ARTICLE
AU  - Owen Martyn Bendor-Samuel
AU  - Aparna Pal
AU  - Simon Cudlip
AU  - Gemma Anderson
AU  - Sanjay Salgia
AU  - Tafadzwa Makaya
TI  - Pituitary gigantism: a rare learning opportunity
AID  - 10.1136/archdischild-2018-316282
DP  - 2020 Apr 01
TA  - Archives of disease in childhood - Education & practice edition
PG  - 111--116
VI  - 105
IP  - 2
4099  - http://ep.bmj.com/content/105/2/111.short
4100  - http://ep.bmj.com/content/105/2/111.full
SO  - Arch Dis Child Educ Pract Ed2020 Apr 01; 105
AB  - Introduction Pituitary gigantism is a rare but significant paediatric condition with complexities surrounding diagnosis and management. Transsphenoidal surgery (TSS) is the treatment of choice; however, medical treatment is often considered as adjuvant therapy.Case A 10½ -year-old boy presented with tall stature and a height velocity of 11 cm/year. His height was 178.7 cm (+5.8 SD above mean) and insulin-like growth factor-1 (IGF-1) was elevated. An oral glucose tolerance test demonstrated non-suppression of growth hormone (GH). Initial contrast MRI was inconclusive, but C-11 methionine functional positron emission tomography CT identified a 6 mm pituitary microadenoma. A multidisciplinary team clinic held with the family allowed discussion about medical and surgical treatment options. Due to a number of factors including the patient’s young age, prepubertal status, a wish to allow him to settle into his new high school and his desire to reach a final height taller than his father’s height, it was decided to try medical therapy first with a somatostatin analogue. Pubertal induction was also commenced and bilateral epiphysiodesis surgery performed. Initial response to octreotide was positive; however, 4 months into therapy his IGF-1 was climbing and a repeat GH profile was not fully suppressed. The patient therefore proceeded to have successful TSS excision of the adenoma.Conclusion Rare cases such as this require sharing of knowledge and expertise, so the best possible care is offered. It is often necessary to work across sites and disciplines. Each case requires an individual approach tailored to the patient and their family.