GIGANTISM

GIGANTISM: Excerpt from Differential Diagnosis in Primary Care

The differential of this symptom can be developed physiologically by overactivity or underactivity of an endocrine gland. Thus, overactivity of the pituitary gland (as in eosinophilic adenomas of the pituitary) causes gigantism from too much growth hormone, whereas underactivity of the testicles (as in Klinefelter syndrome) produces a tall individual because the inadequate secretion of testosterone delays closure of the epiphysis. Tumors of the adrenal cortex, testicle, and pineal gland may produce macrogenitosomia or prepubertal gigantism by stimulation of overgrowth by androgens and estrogens only to lead to ultimate dwarfism by premature closure of the epiphysis.

GIGANTISM

Primary gigantism is like the gigantism of plants and flowers; genetic arachnodactyly is also a genetic form of gigantism, although it is a true disease and is associated with dislocation of the lens.

Approach to the Diagnosis

The approach to the diagnosis of these conditions is simple. RIA studies of the hormone levels are now readily available and x-rays of the skull with CT scans and tomography will allow a diagnosis. Referral to an endocrinologist may be wise from the start, especially because potentially tall girls may want endocrine therapy to close the epiphysis early.

Other Useful Tests

1. Serum growth hormone (pituitary adenoma)
2. Serum corticotropin, LH, and FSH levels (pituitary adenoma)
3. Serum testosterone (Klinefelter syndrome, adrenal tumors, and hyperplasia)
4. Serum dihydrotestosterone and dehydroepiandosterone sulfate (adrenal tumor and hyperplasia)
5. Urine hydroxyproline level (Marfan syndrome)
6. Urine homocystine level (homocystinuria)
7. Chromosomal analysis (Klinefelter syndrome)
8. MRI of the pituitary (microadenoma)
9. Testicular biopsy (Klinefelter syndrome)

Book Source Details

• Book Title: Differential Diagnosis in Primary Care
• Author(s): R. Douglas Collins
• Year of Publication: 2007
• Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8

 » Next page: Acromegaly and gigantism (Professional Guide to Diseases (Eighth Edition))

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