Abstract
Normal growth as well as acromegaloid features have been described in patients after HY for craniopharyngioma. This growth has been attributed to multiple factors including prolactin, ICF-I, insulin and anti-GH receptor antibodies. We have followed for 18 y a now 22 year old male who was HY for a craniopharyngioma at age 4. Subsequently he was replaced with thyroid, cortisone DDAVP and low dose halotestin. He grew normally and attained a final height of 179.5 cm (+2 S.D. for T.H.; + 0.4 SD for C.A.); weight 96 kg, 30 % above IBU, BMI 30 kg/m2. He had coarse features, large hands and feet, and a calcaneal heal pad of 25 mm, consistent with acromegaly. GH response to arginine, L-dopa, GRF and sleep were < 0.5 ng/ml. Circulating Prl< 2 ng/ml, IGF-1 17 ng/dl, IGF-II 104 mcg/1 and IGF-BP3 0.4 mg/l were very low. No plasma GH bio-activity was detected, He had a strikingly elevated insulin response to an OGTT(peak > 400 mu/l) basal insulin and glucose tolerance were normal, consistent with insulin resistance. We postulate two mechanisms by which insulin induced the growth promotion and acromegaloid features in the presence of very low GH, IGF-I and Prl: the frequent and strikingly elevated concentrations of plasma insulin in response to feeding 1) act on the IGF-1 receptor to produce an ICF-I effect and 2) the hyperinsulinemia increases local IGF-I production in cartilage (Alarid et al Endocrinology 130: 2305, 1992). He suggest the combination of these two effects of HI account for the growth pattern and acromegaloid features of this and similar patients.
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Silverman, L., Grumbach, M. & Conte, F. GROWTH AND ACROHEGALOID FEATURES IN A HYPOPHYSECTOMIZED (HY) MALE: THE ROLE OF PRANDIAL HYPERINSULINISM (HI). Pediatr Res 33 (Suppl 5), S65 (1993). https://doi.org/10.1203/00006450-199305001-00373
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DOI: https://doi.org/10.1203/00006450-199305001-00373