A 25-year-old lady presen...

A 25-year-old lady presented with increased stature growth and enlarged body parts noticed since the age of 14, with primary amenorrhea and frontal headache for the last two years. She has also been suffering from non-inflammatory low back pain with progressive kyphosis and pain in the knees, ankles, and elbows from the prior five years. There was no H/o visual disturbance, vomiting, galactorrhoea, cold intolerance. In addition, she had no siblings and no significant family history. She had a height of 221 cm, weight of 138 kg and BMI of 28. As shown in the figure, there was coarsening of facial features along with frontal bossing and prognathism, large hands and feet, and small goitre.

The patient had severe kyphosis and osteoarthritis of the knees. In addition, Confrontation perimetry suggested bitemporal hemianopia. Breast and pubic hair were of Tanner stage 1. Serum IGF1 was 703 ng/ml with all glucose suppressed GH values>40 ng/ml. Prolactin was 174 ng/ml. Basal LH and FSH levels were low. The standard was for the oral glucose tolerance test, liver and renal function tests, basal cortisol and thyroid profile, Calcium, phosphorus, and Intact Parathyroid hormone. CT of the brain showed a large pituitary macroadenoma, as shown in the figure. A diagnosis of gigantism was made.