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García WR, Cortes HT, Romero AF. Pituitary gigantism: a case series from Hospital de San José (Bogotá, Colombia). ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2019; 63:385-393. [PMID: 31365626 PMCID: PMC10528647 DOI: 10.20945/2359-3997000000150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 04/24/2019] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Gigantism is a rare pediatric disease characterized by increased production of growth hormone (GH) before epiphyseal closure, that manifests clinically as tall stature, musculoskeletal abnormalities, and multiple comorbidities. MATERIALS AND METHODS Case series of 6 male patients with gigantism evaluated at the Endocrinology Service of Hospital de San José (Bogotá, Colombia) between 2010 and 2016. RESULTS All patients had macroadenomas and their mean final height was 2.01 m. The mean age at diagnosis was 16 years, and the most common symptoms were headache (66%) and hyperhidrosis (66%). All patients had acral changes, and one had visual impairment secondary to compression of the optic chiasm. All patients underwent surgery, and 5 (83%) required additional therapy for biochemical control, including radiotherapy (n = 4, 66%), somatostatin analogues (n = 5, 83%), cabergoline (n = 3, 50%), and pegvisomant (n = 2, 33%). Three patients (50%) achieved complete biochemical control, while 2 patients showed IGF-1 normalization with pegvisomant. Two patients were genetically related and presented a mutation in the aryl hydrocarbon receptor-interacting protein (AIP) gene (pathogenic variant, c.504G>A in exon 4, p.Trp168*), fulfilling the diagnostic criteria of familial isolated pituitary adenoma. CONCLUSIONS This is the largest case series of patients with gigantism described to date in Colombia. Transsphenoidal surgery was the first-choice procedure, but additional pharmacological therapy was usually required. Mutations in the AIP gene should be considered in familial cases of GH-producing adenomas.
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Affiliation(s)
- William Rojas García
- Hospital de San JoséEndocrinology UnitHospital de San JoséColombia Head of the Endocrinology Unit, Hospital de San José;
- Fundación Universitaria de Ciencias de la SaludBogotáDCColombiaassociate professor, Fundación Universitaria de Ciencias de la Salud, Bogotá, DC, Colombia
| | - Henry Tovar Cortes
- Hospital de San JoséColombiaHospital de San José;
- Fundación Universitaria de Ciencias de la SaludBogotáDCColombiaassistant professor, Fundación Universitaria de Ciencias de la Salud, Bogotá, DC, Colombia
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Mangupli R, Rostomyan L, Castermans E, Caberg JH, Camperos P, Krivoy J, Cuauro E, Bours V, Daly AF, Beckers A. Combined treatment with octreotide LAR and pegvisomant in patients with pituitary gigantism: clinical evaluation and genetic screening. Pituitary 2016; 19:507-14. [PMID: 27287035 DOI: 10.1007/s11102-016-0732-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Pituitary gigantism is a rare condition caused by growth hormone secreting hypersecretion, usually by a pituitary tumor. Acromegaly and gigantism cases that have a genetic cause are challenging to treat, due to large tumor size and poor responses to some medical therapies (e.g. AIP mutation affected cases and those with X-linked acrogigantism syndrome). MATERIALS AND METHODS We performed a retrospective study to identify gigantism cases among 160 somatotropinoma patients treated between 1985 and 2015 at the University Hospital of Caracas, Venezuela. We studied clinical details at diagnosis, hormonal responses to therapy and undertook targeted genetic testing. Among the 160 cases, eight patients (six males; 75 %) were diagnosed with pituitary gigantism and underwent genetic analysis that included array comparative genome hybridization for Xq26.3 duplications. RESULTS All patients had GH secreting pituitary macroadenomas that were difficult to control with conventional treatment options, such as surgery or primary somatostatin receptor ligand (SRL) therapy. Combined therapy (long-acting SRL and pegvisomant) as primary treatment or after pituitary surgery and radiotherapy permitted the normalization of IGF-1 levels and clinical improvement. Novel AIP mutations were the found in three patients. None of the patients had Xq26.3 microduplications. CONCLUSIONS Treatment of pituitary gigantism is frequently challenging; delayed control increases the harmful effects of GH excess, such as, excessive stature and symptom burden, so early diagnosis and effective treatment are particularly important in these cases.
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Affiliation(s)
- Ruth Mangupli
- Section of Neuroendocrinology, Department of Neurosurgery, Hospital Universitario de Caracas, Caracas, Venezuela.
| | - Liliya Rostomyan
- Department of Endocrinology, Centre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000, Liège, Belgium
| | - Emilie Castermans
- Department of Human Genetics, Centre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000, Liège, Belgium
| | - Jean-Hubert Caberg
- Department of Human Genetics, Centre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000, Liège, Belgium
| | - Paul Camperos
- Section of Neuroendocrinology, Department of Neurosurgery, Hospital Universitario de Caracas, Caracas, Venezuela
| | - Jaime Krivoy
- Section of Neuroendocrinology, Department of Neurosurgery, Hospital Universitario de Caracas, Caracas, Venezuela
| | - Elvia Cuauro
- Section of Neuroendocrinology, Department of Neurosurgery, Hospital Universitario de Caracas, Caracas, Venezuela
| | - Vincent Bours
- Department of Human Genetics, Centre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000, Liège, Belgium
| | - Adrian F Daly
- Department of Endocrinology, Centre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000, Liège, Belgium
| | - Albert Beckers
- Department of Endocrinology, Centre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000, Liège, Belgium.
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Naves LA, Daly AF, Dias LA, Yuan B, Zakir JCO, Barra GB, Palmeira L, Villa C, Trivellin G, Júnior AJ, Neto FFC, Liu P, Pellegata NS, Stratakis CA, Lupski JR, Beckers A. Aggressive tumor growth and clinical evolution in a patient with X-linked acro-gigantism syndrome. Endocrine 2016; 51:236-44. [PMID: 26607152 PMCID: PMC5497487 DOI: 10.1007/s12020-015-0804-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 11/06/2015] [Indexed: 10/22/2022]
Abstract
X-linked acro-gigantism (X-LAG) syndrome is a newly described disease caused by microduplications on chromosome Xq26.3 leading to copy number gain of GPR101. We describe the clinical progress of a sporadic male X-LAG syndrome patient with an Xq26.3 microduplication, highlighting the aggressive natural history of pituitary tumor growth in the absence of treatment. The patient first presented elsewhere aged 5 years 8 months with a history of excessive growth for >2 years. His height was 163 cm, his weight was 36 kg, and he had markedly elevated GH and IGF-1. MRI showed a non-invasive sellar mass measuring 32.5 × 23.9 × 29.1 mm. Treatment was declined and the family was lost to follow-up. At the age of 10 years and 7 months, he presented again with headaches, seizures, and visual disturbance. His height had increased to 197 cm. MRI showed an invasive mass measuring 56.2 × 58.1 × 45.0 mm, with compression of optic chiasma, bilateral cavernous sinus invasion, and hydrocephalus. His thyrotrope, corticotrope, and gonadotrope axes were deficient. Surgery, somatostatin analogs, and cabergoline did not control vertical growth and pegvisomant was added, although vertical growth continues (currently 207 cm at 11 years 7 months of age). X-LAG syndrome is a new genomic disorder in which early-onset pituitary tumorigenesis can lead to marked overgrowth and gigantism. This case illustrates the aggressive nature of tumor evolution and the challenging clinical management in X-LAG syndrome.
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Affiliation(s)
- Luciana A Naves
- Department of Endocrinology, Faculty of Medicine, University of Brasilia, Brasília, Brazil.
| | - Adrian F Daly
- Departments of Endocrinology, Centre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000, Liège, Belgium
| | - Luiz Augusto Dias
- Department of Neurosurgery, Federal District Base Hospital, Brasília, Brazil
| | - Bo Yuan
- Departments of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | | | | | - Leonor Palmeira
- Departments of Endocrinology, Centre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000, Liège, Belgium
| | - Chiara Villa
- Departments of Endocrinology, Centre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000, Liège, Belgium
- Department of Pathology, Hopital Foch, Suresnes Cedex, France
| | - Giampaolo Trivellin
- Section on Endocrinology and Genetics, Program on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, MD, 20892, USA
| | - Armindo Jreige Júnior
- Department of Endocrinology, Faculty of Medicine, University of Brasilia, Brasília, Brazil
| | | | - Pengfei Liu
- Departments of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | | | - Constantine A Stratakis
- Section on Endocrinology and Genetics, Program on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, MD, 20892, USA
| | - James R Lupski
- Departments of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Texas Children's Hospital, Houston, TX, USA
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Albert Beckers
- Departments of Endocrinology, Centre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000, Liège, Belgium.
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Beckers A, Lodish MB, Trivellin G, Rostomyan L, Lee M, Faucz FR, Yuan B, Choong CS, Caberg JH, Verrua E, Naves LA, Cheetham TD, Young J, Lysy PA, Petrossians P, Cotterill A, Shah NS, Metzger D, Castermans E, Ambrosio MR, Villa C, Strebkova N, Mazerkina N, Gaillard S, Barra GB, Casulari LA, Neggers SJ, Salvatori R, Jaffrain-Rea ML, Zacharin M, Santamaria BL, Zacharieva S, Lim EM, Mantovani G, Zatelli MC, Collins MT, Bonneville JF, Quezado M, Chittiboina P, Oldfield EH, Bours V, Liu P, De Herder W, Pellegata N, Lupski JR, Daly AF, Stratakis CA. X-linked acrogigantism syndrome: clinical profile and therapeutic responses. Endocr Relat Cancer 2015; 22:353-67. [PMID: 25712922 PMCID: PMC4433400 DOI: 10.1530/erc-15-0038] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2015] [Indexed: 12/31/2022]
Abstract
X-linked acrogigantism (X-LAG) is a new syndrome of pituitary gigantism, caused by microduplications on chromosome Xq26.3, encompassing the gene GPR101, which is highly upregulated in pituitary tumors. We conducted this study to explore the clinical, radiological, and hormonal phenotype and responses to therapy in patients with X-LAG syndrome. The study included 18 patients (13 sporadic) with X-LAG and microduplication of chromosome Xq26.3. All sporadic cases had unique duplications and the inheritance pattern in two families was dominant, with all Xq26.3 duplication carriers being affected. Patients began to grow rapidly as early as 2-3 months of age (median 12 months). At diagnosis (median delay 27 months), patients had a median height and weight standard deviation scores (SDS) of >+3.9 SDS. Apart from the increased overall body size, the children had acromegalic symptoms including acral enlargement and facial coarsening. More than a third of cases had increased appetite. Patients had marked hypersecretion of GH/IGF1 and usually prolactin, due to a pituitary macroadenoma or hyperplasia. Primary neurosurgical control was achieved with extensive anterior pituitary resection, but postoperative hypopituitarism was frequent. Control with somatostatin analogs was not readily achieved despite moderate to high levels of expression of somatostatin receptor subtype-2 in tumor tissue. Postoperative use of adjuvant pegvisomant resulted in control of IGF1 in all five cases where it was employed. X-LAG is a new infant-onset gigantism syndrome that has a severe clinical phenotype leading to challenging disease management.
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Affiliation(s)
- Albert Beckers
- Department of Endocrinology, Centre Hospitalier Universitaire de Liège, University of Liège, Liège, Belgium
| | - Maya Beth Lodish
- Program on Developmental Endocrinology and Genetics, Section on Endocrinology & Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD
| | - Giampaolo Trivellin
- Program on Developmental Endocrinology and Genetics, Section on Endocrinology & Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD
| | - Liliya Rostomyan
- Department of Endocrinology, Centre Hospitalier Universitaire de Liège, University of Liège, Liège, Belgium
| | - Misu Lee
- Helmholtz Zentrum München, Institute of Pathology, Neuherberg, Germany
| | - Fabio R Faucz
- Program on Developmental Endocrinology and Genetics, Section on Endocrinology & Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD
| | - Bo Yuan
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX
| | - Catherine S Choong
- Department of Pediatric Endocrinology & Diabetes, Princess Margaret Hospital for Children, Subiaco WA, Australia
| | - Jean-Hubert Caberg
- Department of Clinical Genetics, Centre Hospitalier Universitaire de Liège, University of Liège, Liège, Belgium
| | - Elisa Verrua
- Endocrinology and Diabetology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | | | - Tim D Cheetham
- Department of Paediatric Endocrinology, Royal Victoria Infirmary, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jacques Young
- INSERM U 693, GHU Paris-Sud - Hôpital de Bicêtre, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Philippe A Lysy
- Pediatric Endocrinology Unit, Université Catholique de Louvain, Bruxelles, Belgium
| | - Patrick Petrossians
- Department of Endocrinology, Centre Hospitalier Universitaire de Liège, University of Liège, Liège, Belgium
| | - Andrew Cotterill
- Mater Medical Research Institute, University of Queensland, Brisbane, Queensland, Australia
| | | | - Daniel Metzger
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX
| | - Emilie Castermans
- Department of Clinical Genetics, Centre Hospitalier Universitaire de Liège, University of Liège, Liège, Belgium
| | - Maria Rosaria Ambrosio
- Department of Medical Sciences, Section of Endocrinology, University of Ferrara, Ferrara, Italy
| | - Chiara Villa
- Department of Endocrinology, Centre Hospitalier Universitaire de Liège, University of Liège, Liège, Belgium
- Service d’Anatomie et Cytologie Pathologiques, Hopital Foch, Suresnes, France
- INSERM Unité 1016, Institut Cochin, Hopital Cochin, Université Paris Descartes, Paris, France
| | - Natalia Strebkova
- Endocrinological Research Centre, Institute of Pediatric Endocrinology, Moscow, Russia
| | - Nadia Mazerkina
- Service d’Anatomie et Cytologie Pathologiques, Hopital Foch, Suresnes, France
- Burdenko Neurosurgery Institute, Moscow, Russia
| | | | | | | | - Sebastian J. Neggers
- Department of Medicine, Section of Endocrinology, Erasmus University Medical Center Rotterdam / Pituitary Center Rotterdam, Rotterdam, The Netherlands
| | - Roberto Salvatori
- Department of Endocrinology, Johns Hopkins University, Baltimore, Maryland, United States
| | - Marie-Lise Jaffrain-Rea
- Department of Endocrinology, University of L’Aquila, IRCCS, L’Aquila, and Neuromed, Pozilli, Italy
| | - Margaret Zacharin
- Department of Endocrinology and Diabetes The Royal Children’s Hospital, Melbourne, Victoria, Australia
| | | | - Sabina Zacharieva
- Clinical Center of Endocrinology and Gerontology, Medical University of Sofia, Sofia, Bulgaria
| | - Ee Mun Lim
- Department of Clinical Biochemistry, Pharmacology & Toxicology, PathWest QEII-Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Giovanna Mantovani
- Endocrinology and Diabetology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Maria Chaira Zatelli
- Department of Medical Sciences, Section of Endocrinology, University of Ferrara, Ferrara, Italy
| | - Michael T Collins
- Skeletal Clinical Studies Unit, National Institute of Dental and Craniofacial Research, NIH, Bethesda, Maryland, USA
| | - Jean-François Bonneville
- Department of Endocrinology, Centre Hospitalier Universitaire de Liège, University of Liège, Liège, Belgium
| | - Martha Quezado
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health (NIH), Bethesda, Maryland, 20892, USA
| | - Prashant Chittiboina
- National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland, USA
| | - Edward H. Oldfield
- Department of Neurosurgery, University of Virginia Medical School, Charlottesville, Virginia, USA
| | - Vincent Bours
- Department of Clinical Genetics, Centre Hospitalier Universitaire de Liège, University of Liège, Liège, Belgium
| | - Pengfei Liu
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX
| | - Wouter De Herder
- Department of Medicine, Section of Endocrinology, Erasmus University Medical Center Rotterdam / Pituitary Center Rotterdam, Rotterdam, The Netherlands
| | - Natalia Pellegata
- Helmholtz Zentrum München, Institute of Pathology, Neuherberg, Germany
| | - James R. Lupski
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX
- Department of Pediatrics, and Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas, USA
- Texas Children’s Hospital, Houston, Texas, USA
| | - Adrian F. Daly
- Department of Endocrinology, Centre Hospitalier Universitaire de Liège, University of Liège, Liège, Belgium
| | - Constantine A. Stratakis
- Program on Developmental Endocrinology and Genetics, Section on Endocrinology & Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD
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