A 24-Year-Old Male with Gigantism, Growth Hormone Deficiency, Suspected Clivus Chordoma, Primary Hypothyroidism, Hypogonadism and Pancytopenia

Abstract

Preeliminary : Pituitary gigantism is a condition caused by the excessive secretion of growth hormone (GH). Growth Hormone is also the most common pituitary hormone deficient in pituitary disease. Chordoma is a bone primary tumor that grows slowly and rarely found. Hypothyroidism is a pathological condition due to thyroid hormone deficiency. Symptoms of hypogonadism is non-specific including libido disorders, erectile dysfunction and decreased muscle mass and no hair growth in the head or body. Case : A 24-year-old man came with a knee-jerk complaint. Physical examination obtained increased growth of statural and body parts as well as loss of body hair. Laboratory investigation revealed pancytopenia, increased prolactin; decreased GH, IGF-1 and testosterone; increased TSH, decreased FT3 and FT4. Head MRI demonstrated the presence of mass in the clivus.Discussion : In this case, the patient presents with clinical gigantism. However, laboratory examination shows decreased GH and IGF-1 which may be due to the suppressive effect of mass on the clivus bone to the pituitary. The suspicion of hypothyroid found alone or due to mass in the clivus bone still requires further examination. Hypogonadism can result from supression on the pituitary. Pancytopenia can be caused by deficiency of GH or from hypothyroidism.Conclusion : Gigantism may occurred with deficiency GH and IGF-1 due to suppressed pituitary caused by chordoma.