Weng Hong CHUNG, Chee Kidd CHİU, Chris Yin Wei CHAN, Mun Keong KWAN

Rapid progression of scoliosis curve in a mature patient with undiagnosed pituitary macroadenoma: A rare case report

Growth hormone secreting pituitary tumor or gigantism has not been previously reported to be associated with rapid progression of scoliosis in the literature. However, there are some reports indicating scoliosis can be worsened by growth hormone therapy in children and adolescents. A 19-year-old boy was referred to our institution for the treatment of a right thoracolumbar scoliosis. The Cobb angle had worsened from 29° to 83° over two years’ duration. He attained puberty at the age of 13. He had a previous history of slipped upper femoral epiphysis (SUFE), which was operated in 2015, with no clinical features of gigantism. Preoperative assessment was performed. He was diagnosed with growth hormone secreting pituitary macroadenoma by magnetic resonance imaging with a high serum level of insulin-like growth factor-I (IGF-I). Computed tomography (CT) of the pancreas showed a pancreatic endocrine tumor. The patient was later diagnosed with multiple endocrine neoplasia type 1 (MEN 1). He underwent endoscopic endonasal excision of the pituitary mass and distal pancreatectomy. This case indicates that growth hormone secreting pituitary macroadenoma could result in rapid progression of scoliosis.

___

1. Cheung JPY, Cheung PWH, Samartzis D, Dip-Kei Luk K. Curve progression in adolescent idiopathic scoliosis does not match skeletal growth. Clin Orthop Relat Res 2018; 476: 429-36. [Crossref]

2. Villwock JA, Villwock M, Deshaies E, Goyal P. Significant increases of pituitary tumors and resections from 1993 to 2011. Int Forum Allergy Rhinol 2014; 4: 767-70. [Crossref]

3. Fernandez A, Karavitaki N, Wass JA. Prevalence of pituitary adenomas: a community-based, cross-sectional study in Banbury (Oxfordshire, UK). Clin Endocrinol (Oxf) 2010; 72: 377-82. [Crossref]

4. Molitch ME. Diagnosis and treatment of pituitary adenomas: A review. JAMA 2017; 317: 516-24. [Crossref]

5. Barkan AL. Biochemical markers of acromegaly: GH vs. IGF-I. Growth Horm IGF Res 2004; 14 Suppl A:S97-100. [Crossref]

6. Dymling JF, Willner S. Progression of a structural scoliosis during treatment with growth hormone. A case report. Acta Orthop Scand 1978; 49: 264-8. [Crossref]

7. Critical Evaluation of the Safety of Recombinant Human Growth Hormone Administration: Statement from the Growth Hormone Research Society1. J Clin Endocrinol Metab 2001; 86: 1868-70. [Crossref]

8. Bell J, Parker KL, Swinford RD, Hoffman AR, Maneatis T, Lippe B. Longterm safety of recombinant human growth hormone in children. J Clin Endocrinol Metab 2010; 95: 167-77. [Crossref]

9. Craig ME, Cowell CT, Larsson P, et al. Growth hormone treatment and adverse events in Prader-Willi syndrome: data from KIGS (the Pfizer International Growth Database). Clin Endocrinol 2006; 65: 178-85. [Crossref]

10. Kim JY, Rosenfeld SR, Keyak JH. Increased prevalence of scoliosis in Turner syndrome. J Pediatr Orthop 2001; 21: 765-6. [Crossref]

11. Wang ED, Drummond DS, Dormans JP, Moshang T, Davidson RS, Gruccio D. Scoliosis in patients treated with growth hormone. J Pediatr Orthop 1997; 17: 708-11. [Crossref]