Goldenberg N, Racine MS, Thomas P, Degnan B, Chandler W, Barkan A. Treatment of pituitary gigantism with the growth hormone receptor antagonist pegvisomant.
J Clin Endocrinol Metab 2008;
93:2953-6. [PMID:
18492755 PMCID:
PMC2515082 DOI:
10.1210/jc.2007-2283]
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Abstract
CONTEXT
Treatment of pituitary gigantism is complex and the results are usually unsatisfactory.
OBJECTIVE
The objective of the study was to describe the results of therapy of three children with pituitary gigantism by a GH receptor antagonist, pegvisomant.
DESIGN
This was a descriptive case series of up to 3.5 yr duration.
SETTING
The study was conducted at a university hospital.
PATIENTS
Patients included three children (one female, two males) with pituitary gigantism whose GH hypersecretion was incompletely controlled by surgery, somatostatin analog, and dopamine agonist.
INTERVENTION
The intervention was administration of pegvisomant.
MAIN OUTCOME MEASURES
Plasma IGF-I and growth velocity were measured.
RESULTS
In all three children, pegvisomant rapidly decreased plasma IGF-I concentrations. Growth velocity declined to subnormal or normal values. Statural growth fell into lower growth percentiles and acromegalic features resolved. Pituitary tumor size did not change in two children but increased in one boy despite concomitant therapy with a somatostatin analog.
CONCLUSIONS
Pegvisomant may be an effective modality for the therapy of pituitary gigantism in children. Titration of the dose is necessary for optimal efficacy, and regular surveillance of tumor size is mandatory.
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