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Serial hormonal studies were carried out in a girl with a growth hormone- secreting pituitary adenoma and hyperprolactinemia diagnosed at 21 months of age,the youngest verified case of acromegaly.The child had progressive macrocephaly,noted at 6 months of age,which preceded the rapid acceleration of linear growth by nearly 1 year.At 21 months of age,the girl's head circumference measured 55 cm(+5.5 SD)and her height was 97.6 cm(+4.4 SD).Preoperative serum growth hormone level was 135 ng/mL, somatomedin C was 1,540 ng/mL(normal for bone age 18 to 97 ng/mL),and prolactin was 370 ng/mL(normal<20 ng/mL).Following total resection of a large adenoma,immunohistochemical staining of the tumor showed growth hormone but not prolactin.With longitudinal monitoring of the child for 2 years postoperatively,persistently low growth hormone levels were demonstrated and normal growth velocity(6 cm/yr).Peak serum growth hormone levels ranged from 2.8 to 4.1 ng/mL after stimulation tests with insulin, arginine,and L-dopa.Maximum sleep-entrained growth hormone level was 3.4 ng/mL.At the same time,serum somatomedin C levels measured serially were normal(29 to 111 ng/mL),whereas simultaneous prolactin levels were moderately increased(30 to 147 ng/mL).The data support the hypothesis that hyperprolactinemia may have contributed to stimulating somatomedin C and sustaining the normal growth rate of this child. |
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acromegaly
children
growth hormone
macrocephaly
neoplasm,pituitary
neoplasm,primary of CNS-infants
neuroendocrinology
pituitary,adenoma
prolactin,elevated
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