Endocrine Abstracts

Introduction

Acromegalo-gigantism is a rare disease, occurring before the epiphyses weld, it causes a linear acceleration of growth in children and adolescents. Medical treatment with analogues of somatostatin (AS) well established can be used in cases where surgery is impossible or inadequate or in cases of surgical failure

Observation

This is a 14-year-old patient, followed for acromegalo-gigantism discovered at the age of 7. The patient has a height of 1.88 m (+3 SD), a Tanner stage G4P4 and features of acromegaly. The diagnosis was made in front of an IGF1 level at 791ng/mL (1.6 × normal) with pituitary MRI a pituitary macroadenoma of 16 × 11 × 11mm somatotropic on anathomopathologic pituitary examination with Ki-67 proliferation index < 1. The rest of the hypophysiogram was normal. The patient was operated on twice: in 2015 by the upper route and revision surgery by the transphenoidal route in 2017 associated with treatment with somatostatin analogues (octreotide 200 µg/day) were indicated for failure of the surgery. The course after surgery was marked by continued growth, an IGF1 level raised to 801 ng/mL (1, 6 × normal) and on pituitary MRI a residue of 11.7 × 7 mm. The patient is placed on lanreotide LP 120 mg/28 days with then reconciliation of the injections every 21 days.The course under treatment is marked by clinical improvement with slowing of the growth rate, normalization of the IGF1 level to 441ng/mL (115-489).

Discussion and Conclusion

Control of acromegaly with lanreotide is not always easysome are more sensitive than others, this is due to the involvement of specific genetic factors. The observation of our case highlights the difficulty of managing pituitary gigantism and the encouraging results of medical treatment with lanreotide.