DOI: 10.12890/2026_007424
Beware of tall stature: growth hormone excess associated with a rare parasellar extra-axial tumour—diagnostic and management challenges in a resource-limited setting
Authors
nur-r@fk.unair.ac.id
Keywords
Pituitary gigantism, growth hormone excess, refractory epilepsy, parasella extra-axial tumourAbstract
Introduction: Tall stature can be the sole indicator of growth hormone (GH) excess, which causes pituitary gigantism before epiphyseal fusion. In developing regions like Indonesia, a lack of systematic screening often delays diagnosis. While classic presentations involve accelerated linear growth, atypical cases may be dominated by neurological signs, such as seizures secondary to tumour mass effect.
Case description: A 14-year-old boy presented with a 2-year history of rapidly accelerating growth velocity, increasing shoe size, and a 6-month history of severe morning headaches accompanied by drug-resistant focal seizures. Endocrine evaluations revealed significantly elevated basal GH (4.27 ng/ml) and insulin-like growth factor 1 (IGF-1) levels (536 ng/ml). Brain magnetic resonance imaging identified a large parasellar extra-axial tumour with suprasellar extension. The patient underwent a craniotomy and tumour excision; histopathology subsequently confirmed a rare, aggressive malignant mesenchymal tumour. Postoperatively, the patient achieved seizure resolution and normalization of GH and IGF-1 levels. However, he developed evolving pituitary dysfunction consistent with multiple pituitary hormone deficiency (MPHD), specifically central hypothyroidism, necessitating targeted hormonal replacement therapy and continuous clinical follow-up.
Conclusion: GH excess and gigantism can arise secondary to parasellar pathology rather than intrinsic pituitary disease, with neurological features like refractory epilepsy occasionally preceding classic endocrine manifestations. Rapid adolescent growth paired with neurological signs warrants urgent structural neuroimaging. Meticulous perioperative pituitary monitoring and early multidisciplinary involvement are essential to optimize long-term patient outcomes
References
- Sada V, Puliani G, Feola T, Pirchio R, Pofi R, Sesti F, et al. Tall stature and gigantism in transition age: clinical and genetic aspects-a literature review and recommendations. J Endocrinol Invest. 2024;47(4):777-793. doi: 10.1007/s40618-023-02223-z.
- Asa SL, Ezzat S. An Update on Pituitary Neuroendocrine Tumors Leading to Acromegaly and Gigantism. J Clin Med. 2021;10(11):2254. doi: 10.3390/jcm10112254.
- Gatto F, Perez-Rivas LG, Olarescu NC, Khandeva P, Chachlaki K, Trivellin G, et al. Diagnosis and Treatment of Parasellar Lesions. Neuroendocrinology. 2020;110(9-10):728-739. doi: 10.1159/000506905.
- Novina N, Hermanussen M, Scheffler C, Pulungan AB, Ismiarto YD, Andriyana Y, et al. Indonesian National Growth Reference Charts Better Reflect Height and Weight of Children in West Java, Indonesia, than WHO Child Growth Standards. J Clin Res Pediatr Endocrinol. 2020;12(4):410-419. doi: 10.4274/jcrpe.galenos.2020.2020.0044.
- Dewi MM, Tajul R, Syuhada A, Sobana M. Karakteristik dan Luaran Tumor Otak pada Anak di Rumah Sakit Hasan Sadikin Bandung. Sari Pediatri. 2023;25(2):87–92.
- Colao A, Pivonello R, Di Somma C, Tauchmanovà L, Savastano S, Lombardi G. Growth hormone excess with onset in adolescence: clinical appearance and long-term treatment outcome. Clin Endocrinol (Oxf). 2007;66(5):714-22. doi: 10.1111/j.1365-2265.2007.02809.x.
- Coutant R, Donzeau A, Decrequy A, Louvigné M, Bouhours-Nouet N. How to investigate a child with excessive growth? Ann Endocrinol (Paris). 2017;78(2):98-103. doi: 10.1016/j.ando.2017.04.006.
- Flores-Sobrecueva A, Paláu-Hernández S, Cruz-Rosales JL, Hernández-Rodríguez HG, Reyes-Vaca JG, Shiguetomi-Medina JM, et al. A relationship between drug-resistant epilepsy and structural abnormalities in neuroimaging. Revista Mexicana de Neurociencia. 2020;21(1). doi: 10.24875/RMN.19000090.
- Wang F, Han J, Shang X, Li G. Distinct pituitary hormone levels of 184 Chinese children and adolescents with multiple pituitary hormone deficiency: a single-centre study. BMC Pediatr. 2019;19(1):441. doi: 10.1186/s12887-019-1819-6.
- Rochmah N, Faizi M, Yuniari A, Harjantien N. Multiple pituitary hormone deficiency: beware of combined hormones deficiency. Int J Pediatr Endocrinol. 2013;2013(Suppl 1):P198. doi: 10.1186/1687-9856-2013-S1-P198.
