Gigantism

Gigantism is a clinical syndrome characterized by too high growth in children and adolescents.

Usually gigantism is diagnosed in prepubertal or puberty, since it is possible to talk about this pathology only until the process of ossification of epiphyseal cartilage is completed (see below). After that, gigantism turns into another disease – acromegaly – the initial stage of which is. In ICD-10, acromegaly and pituitary gigantism are allocated in one sub–item – E22.0.

The main visual criterion for the diagnosis of gigantism and acromegaly is considered to be pathologically high growth: from 200 cm in men and from 190 cm in women. However, high growth is not always a symptom of the disease. Only those parents who understand that such a feature is not hereditary should worry about the child’s too high growth. However, if you see that the child is developing much faster than his peers, a doctor’s consultation will not hurt.

ETIOLOGY AND CAUSES OF GIGANTISM
The development of gigantism is primarily associated with an increase in the synthesis of somatotropin (somatotropic hormone, STH) – growth hormone, which is produced by the anterior pituitary gland.

Children and adolescents have so-called epiphyseal growth zones: between the sections of tubular bones there are cartilaginous plates “responsible” for growth, it is in these zones that cell division occurs, leading to bone elongation. By the time of adulthood, ossification of these plates should normally occur, due to which bone growth stops.

If the epiphyseal zones are open, and the pituitary gland synthesizes an excessive amount of STH, there is a very rapid growth of bones in length and thickness, often this process is accompanied by an increase in organs and soft tissues.

The causes of gigantism can be various lesions of the pituitary gland: tumors (for example, pituitary adenoma), various intoxications, neuroinfections (encephalitis, meningitis and others), traumatic brain injuries.

CLASSIFICATION OF GIGANTISM
In most cases, gigantism is precisely the initial stage of acromegaly, but it may not be a disease at all. There are several varieties of gigantism, which are characterized by pathologies of the development of certain organs and parts of the body or are not deviations at all.

Acromegalic gigantism.
With this type of gigantism, signs of acromegaly are observed: coarsening of facial features, an increase in the size of the hands and feet, often a disproportionately small head, headaches, decreased mental abilities, etc..

Constitutional (true) gigantism.
With constitutional gigantism, no abnormalities in physiological and mental functions are detected, all parts of the body and organs increase proportionally. Usually, true gigantism is observed in adolescents whose parents have a height much higher than average. Most doctors do not consider this feature a pathology. If clinical studies do not reveal concomitant disorders, treatment is not required, but regular medical supervision is needed.

Partial (partial) gigantism.
This pathology is characterized by a disproportionate increase in individual parts of the body.

Half gigantism.
This kind of gigantism also does not affect the entire body: there is an increase in only one half of the patient’s torso.

Gigantism of internal organs (splanchnomegaly).
Splanchnomegaly is characterized by an increase in internal organs: their size and mass significantly increases.

Eunuchoid gigantism.
This kind of gigantism is a symptom of hypogonadism – a disease associated with deterioration of work or complete dysfunction of the genital glands. With eunuchoid gigantism, limbs are disproportionately elongated, growth zones in the joints remain open, secondary sexual characteristics are not formed.

Cerebral gigantism.
This form of gigantism is provoked by organic brain lesions. Cerebral gigantism is always accompanied by intellectual disabilities.

SYMPTOMS OF GIGANTISM
In addition to a sharp jump in growth (at the age of 10-15 years) and outperformance of peers by this indicator, patients with gigantism also experience headaches, severe fatigue, hormonal disorders (delayed sexual development, infantilism, hirsutism, diabetes mellitus and diabetes insipidus, thyroid dysfunction). An increase in muscle strength can be replaced by muscle weakness and asthenia.

DIAGNOSIS AND TREATMENT OF GIGANTISM
To diagnose gigantism, a laboratory blood test for CTG, computer and magnetic resonance imaging of the brain, X-rays of the skull and hands are performed. In addition, an examination by an ophthalmologist and a neurologist is necessary.

Treatment involves the use of hormonal and/ or radiation therapy, orthopedic correction through plastic surgery is possible.

With timely diagnosis, the prognosis is generally favorable, but inadequate treatment or too late access to a doctor can provoke the development of severe complications. Particular attention should be paid to the risk of infertility, to which all patients with a diagnosis of “gigantism” are exposed.

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