Acromegaly as a Complication of Growth Hormone Therapy

ABSTRACT Objective: Growth hormone (GH) replacement is widely used; however, acromegaly as a complication of overreplacement is rarely reported. This case report explores this complication with the use of weight-based dosing regimens of human GH. Methods: We report progressive features of acromegaly as a consequence of inadvertent overreplacement of GH, initiated for treatment of GH deficiency in an 11-year-old male treated for craniopharyngioma. Results: An 11-year-old male developed panhypopituitarism after transsphenoidal resection of a craniopharyngioma. Human GH (hGH) replacement therapy was subsequently initiated for hypopituitarism, using a weight-based dosing regimen, achieving adequate linear growth. After 9 years of hGH replacement therapy, prognathism and an increase in shoe size were noted, with supporting radiographic evidence of hGH overreplacement. Conclusion: Clinical features of acromegaly can develop as a rare adverse effect of overreplacement of hGH in GH-deficient patients treated with GH. Frequent clinical monitoring with appropriate GH titration should achieve target insulin-like growth factor 1 levels within the appropriate age- and sex-specific reference range. Awareness of the differences between adult and pediatric GH treatment dosing regimens is important as patients transition from childhood to adulthood. This case report provides valuable insight into this issue. Abbreviations: AACE American Association of Clinical Endocrinologists GH growth hormone hGH human growth hormone IGF-1 insulin-like growth factor 1