ESPE Abstracts

Pituitary hyperplasia (PH) is absolute increase in the number of one or more adenohypophyseal cell subtypes, manifesting radiologically as pituitary enlargement beyond what is considered normal. Diagnosis of PH remains predominantly clinical, hormonal, and radiological. Case presentation: we present a clinical course, diagnosis, and management of a case of pituitary gland hyperplasia in 10 years old Egyptian girl, one of twins who sought medical advice when the mother noticed rapid progressive increase in body weight, advancement of height and pubertal advancement compared to her twin sister. Upon examination: her height was on +1.21 SDS, weight on +2.93 SDS, BMI was on +3.29 SDS. She had Tanner 3 breast, Tanner 2 pubic hair, no axillary hair, no menarche. She had enlargement of her extremities (Hands and Feet), enlarged tongue affecting articulation. Bone age was 2 years advanced. Laboratory investigation revealed non- suppressible growth hormone level by performing growth hormone suppression test. High level of IGF-1. GNRH stimulation test revealed LH levels that coincides with central precocious puberty. Dynamic MRI with contrast of pituitary gland revealed bulky pituitary gland with no sizable focal lesion. Diagnosis of pituitary gland hyperplasia manifesting with growth hormone excess (Gigantism) and central precocious puberty was made based upon clinical and laboratory criteria. Growth hormone antagonist (Octreotide) and Gonadotropin releasing hormone analogue (GNRH) were initiated to slow down growth, pubertal progression and advancement respectively. Growth hormone level and IGF-1 returned back to normal levels 3 months after initiation of therapy. Conclusion: PH should be managed by experienced multidisciplinary team. Surgery should be avoided in PH as it rarely progresses. Close follow up is recommended for early detection of any pituitary microadenoma that may develop.