Gigantism is a growth disorder that causes children to grow so tall and large that they look like giants. This condition is caused by excessive growth hormone production.
Children with gigantism have taller and bigger bodies than children of their age. This rare condition is generally caused by a benign tumor in the pituitary gland (pituitary).
Gigantism is different from acromegaly . Acromegaly usually occurs in adults and is often diagnosed at the age of 30–50 years, whereas gigantism occurs before the end of puberty.
Causes of Gigantism
Gigantism is caused by excessive production of growth hormone or growth hormone (GH). This excessive hormone production usually occurs due to a tumor in the pituitary gland .
The pituitary gland is located at the bottom of the brain. This gland plays a role in producing hormones that affect the growth and function of other organs or glands, such as the thyroid gland, adrenal glands, or reproductive organs.
Tumors in the pituitary gland will affect the function of the pituitary gland itself, including affecting the production of growth hormone.
In addition to tumors in the pituitary gland, there are a number of conditions that can increase growth hormone production and trigger gigantism, including:
- Carney complex , which is a genetic disorder that causes the growth of benign tumors in the skin, endocrine glands, and heart
- Multiple endocrine neoplasia type 1 (MEN 1), which is a genetic disorder that causes tumors to grow in the endocrine glands, including the pituitary, parathyroid, or pancreas glands
- McCune-Albright syndrome , which is a genetic disorder that affects the bones and pigment (skin color)
- Neurofibromatosis , which is a genetic disorder that causes tumors to grow in the nervous system
Symptoms of Gigantism
Children with gigantism experience abnormalities in their growth. This disorder will become more obvious as the child gets older.
As previously mentioned, the symptoms of gigantism itself will appear before the end of puberty. Some of the symptoms are:
- Height and weight above the average age
- The size of the hands and feet are very large and thick
- The forehead and chin are wide
- Rough face shape
Gigantism can also be characterized by several other symptoms, such as:
- Frequent headaches
- Late puberty
- Sleep disorders
- Mother's milk (ASI) comes out prematurely
- Irregular menstrual cycles
- Excessive sweating ( hyperhidrosis )
- Easily tired
- Impaired vision
- There are gaps between the teeth
When to see a doctor
Check with your doctor if your child has symptoms of gigantism, especially if the child's height and weight are above the average for their age. Examination by a doctor needs to be done to find out the cause so that the child can get treatment as soon as possible.
It is also necessary to consult a doctor regularly if you are currently or have recently undergone treatment for gigantism. In this condition, the doctor will monitor the progress of the disease and the child's body's response to treatment.
Diagnosis of Gigantism
To diagnose gigantism, the doctor will conduct questions and answers about complaints, as well as the medical history of the patient and his family. After that, the doctor will carry out a physical examination, one of which is with anthropometric measurements.
Anthropometry is performed to measure body dimensions consisting of height, weight, body mass index (BMI), body circumference (waist, hips and other limbs), as well as the thickness of subcutaneous fat. The results of this measurement will be compared with the growth curve.
To confirm the diagnosis, the doctor will carry out supporting examinations with the following methods:
- Blood tests , to measure hormone levels in the body, including growth hormone (GH) and insulin like growth factor-1 (IGF-1)
- Scanning with MRI and CT scans , to find the presence of a pituitary tumor and diagnose the cause of excess GH levels
Treatment for gigantism aims to stop or inhibit the production of growth hormone or growth hormone (GH) in children. Several treatment options that can be given by doctors to treat gigantism are:
Surgery is the main treatment that can be done to treat gigantism. Surgery is performed to remove a pituitary tumor that is pressing on a nerve and triggering an increase in growth hormone production.
Medications may be given as a support treatment after surgery or if surgery cannot be performed. Some types of drugs that can be given are:
- Somatostatin analogues, such as octreotide , lanreotide, and sandeotide , to inhibit GH, insulin, and glucagon secretion
- Growth hormone antagonists, such as pegvisomant , to inhibit GH performance and reduce concentrations of the hormone IGF-1
- Dopamine -receptor agonists , such as bromocriptine and cabergoline, to decrease GH production
D opamine -receptor agonist drugs can be combined with somatostatin analogues to make them more effective.
Radiation therapy or radiotherapy
Radiation therapy is generally recommended if GH levels do not return to normal after surgery. This therapy will usually take several months to years to get effective results. One type of radiotherapy that can be done is gamma ray therapy or gamma knife radiosurgery .
If left untreated, gigantism can cause complications due to continuous excess growth hormone. Some of the complications are:
- Movement of limbs is disturbed, due to muscle weakness
- Damage to the peripheral nervous system ( peripheral neuropathy )
- Sleep apnea
- Heart enlargement
- Disorders of the heart valves
- Metabolic disorders , such as diabetes
In addition, surgical and radiotherapy procedures performed to treat gigantism can also cause a number of complications, such as:
- Adrenal insufficiency (lack of adrenal hormones)
- Diabetes insipidus
Prevention of Gigantism
Gigantism cannot be prevented. If you encounter symptoms of gigantism in children, immediately consult a doctor so that they can be treated quickly. If diagnosed and treated early, complaints can be quickly resolved before they get worse.