In the past, people who suffered from giant stature or hypersomia were often ostracized and put on display as an attraction. It was not until the last century that this attitude slowly changed and giant stature was recognized as a medical condition.
What is giantism?
Giant stature is the term used to describe an unusual and enormously above average height. Generally, those people who are in the top three percent of the tallest in their age and sex class are considered to have giant stature. More specific classifications refer to the cause of the enormous growth. For example, hormonally induced giant stature is referred to as pituitary giant stature, while genetically induced giant stature is referred to as primordial giant stature. Other names for giant growth are hypersomia and gigantism. A special form of gigantism is acromegaly, in which only the body end limbs and the acra of the body, such as the feet, ears, eyes or chin, are enlarged. Giant growth is a very rare phenomenon in Germany. Annually, about three to four out of one million people develop the disease.
Cause
The most common cause of giant stature is a hormonal imbalance. This imbalance can have several triggers. During the growth phase, the pituitary gland (hypophysis), which is responsible for the production and secretion of growth hormones, may be disturbed. In this case, it secretes too much growth hormone, which leads to uncontrolled growth of the body. In most cases, the reason for this disorder is a benign tumor in the pituitary gland. Tumors in the pancreas can also have an effect on growth, since growth hormones are also produced there. However, tumors are not always responsible for hypersomia. A congenital hyperthyroidism or a diabetic disease of the mother during pregnancy can also lead to giant growth in infants, because the hormone balance is also disturbed. Extremely rare triggers for gigantism also include genetic defects such as Klinefelter syndrome, in which males have an extra X chromosome.
Symptoms, symptoms, and signs
The characteristic feature of giant stature is a height far above the average. The average in this case depends on ethnicity, age, and sex. A form of hypersomia is present when the height is in the first percentile. As a rule, in giant stature, all parts of the body grow equally in proportion to the height of the body. However, there are some forms of the condition in which only the extremities and body tips become longer than average. In many cases, giant stature is already noticeable in infants and children. They often suffer from growing pains. Babies and toddlers often cry for this reason. This pain persists into early adulthood and becomes unbearable for some patients. Depending on the type and severity of the giant growth, sufferers often develop postural deformities. These cause additional pain and physical limitations. Visible deformities often become apparent. Another common symptom is joint pain. If the giant growth is hormonal, a number of other complaints can occur. In many cases, the internal organs are damaged. The liver and kidneys are particularly frequently affected. In addition, affected children and adolescents are sexually mature at a remarkably early age. The secondary sexual characteristics are often already strongly pronounced in them before the age of ten.
Diagnosis and course
The most obvious symptom of giant stature is an enormously above-average height, which often exists in early childhood. In addition, there is often severe pain during growth as well as violent growth spurts. Giant stature is diagnosed by evaluating blood values in the laboratory. If these show a strong imbalance in hormone levels, further examinations such as an MRI or X-ray are ordered. In this way, pathological gigantism can be distinguished from natural, purely genetic above-average growth. The course of the disease in gigantism varies greatly and always depends on the severity and treatment options. The most severe burden of rapid and uncontrolled growth is on the skeleton and with it the bones.Bone growth is often not uniform and can lead to serious deformities and postural defects, often accompanied by severe headaches and joint pain. In addition, the disturbed hormone balance also affects the internal organs such as the kidneys or the liver. In many cases, children affected by giant stature are prematurely sexually mature. Secondary sexual characteristics then begin to develop before the age of ten. Despite better treatment options, the average life expectancy of people with giant stature is still significantly lower than that of normal-sized people.
Complications
One of the major complications of giant stature is postural problems. The rapid and uncontrolled growth puts considerable stress on the bones and subsequently leads to deformities, which are often associated with severe headaches and joint pain. The characteristic bulges and enlargement of the nose are also typical. As a result of macroglossia, i.e. the enlargement of the tongue, there is slurred pronunciation. These abnormalities often result in psychological suffering. Thus, giant growth is usually accompanied by inferiority complexes and depression. The disturbed hormone balance overloads the internal organs such as kidneys and liver. Children with gigantism also reach sexual maturity prematurely and also have a reduced life expectancy. If hypersomia is caused by a pituitary tumor, further symptoms such as visual disturbances, visual field defects and neurological disorders may occur. Rarely, the tumor disease is fatal. In the treatment of giant pituitary tumors, there can be a variety of complications, depending on the chosen therapy method. Chemotherapy may cause late effects such as organ damage and hormonal disorders. Hormone therapy can also cause hormonal imbalances and lead to premature menopause in women. Surgery is always associated with risks (for example, injury and bleeding).
When should you go to the doctor?
Hypersomia should always be evaluated by a doctor. With this condition, self-healing does not occur. As a rule, hypersomia cannot be treated properly either, so the affected person has to rely on purely symptomatic treatment. A complete cure cannot be achieved. In most cases, hypersomia does not negatively affect the life expectancy of the affected person. A doctor should be consulted if the patient suffers from giant growth. In this case, the affected person is very tall, and the limbs are also usually very long. Likewise, very severe pain during growth often indicates hypersomia, it should always be examined. Also, if there is pain in the joints, an examination by a doctor is very useful. Usually, hypersomia can be diagnosed by a pediatrician or by a general practitioner. The treatment itself always depends on the exact symptoms and on their severity, so no universal prognosis can be given.
Treatment and therapy
Treatment of giant stature requires successful treatment of the underlying condition. The most common trigger, pituitary tumor, can be treated by several methods. Since surgery near the brain carries great risks, attempts are often first made to target the tumor with radiation or chemotherapy. If, on the other hand, the tumor is malignant in one of the very rare cases, neurosurgical intervention is unavoidable. A similar procedure is used for a tumor in the pancreas. In addition to treatment of the tumor, hormone therapy is often prescribed to inhibit growth. Estrogens and progestins are then used in female patients, and testosterone in male patients. If the risk of giant growth is increased due to gestational diabetes in the mother, this must be optimally treated throughout the pregnancy to prevent excessive growth of the embryo. As a general rule, the sooner treatment of the trigger begins, the greater the chances for an uncomplicated course of the disease. If treatment does not occur until an advanced stage or after the growth phase has ended, permanent postural damage often cannot be averted. In this case, an orthopedist can only try to treat the already existing conditions.
Prevention
Because both attitudes toward people with giant stature and treatment options have improved greatly in recent decades, affected individuals can now be treated much more efficiently and successfully. However, early detection remains the most important thing, which is why a doctor should be consulted even if there are minor signs of giant growth.
Follow-up care
Affected individuals of giant stature (hypersomia) are conspicuous by their above-average size throughout their lives. The disease is congenital and is triggered, among other things, by an excessive release of growth hormones. The body size can only be counteracted to a limited extent by surgery or the administration of appropriate hormones; those affected stand out permanently from the crowd. For this reason, aftercare is mainly in psychotherapeutic form. A specialist will first determine the cause of the giant growth. This may be due to various hereditary diseases or hormonal disorders. The causative disease cannot be subsequently corrected if it is congenital. In the case of hormonal overproduction, appropriate therapy can counteract a further growth spurt. For this, the patient must still be in the growth phase. If giant growth is accompanied by pain in the joints, controlled administration of painkillers is recommended. Psychotherapy can help with the giant growth disorder to get a better grip on existing psychological complaints. The aim is to prevent depression caused by low self-esteem. The affected person learns to cope with his particularity in everyday life. His self-confidence is to be strengthened and stabilized. The therapist must convey to the patient that despite his size, he is by no means ‘wrong’ compared to average-sized people, but only different.
This is what you can do yourself
The possibilities of self-help are few in the case of a giant growth. There are no alternative cures or self-applied measures that lead to a reduction in physical growth. Since the growth process takes place in the first years of life, the affected persons can hardly take initiatives on their own that lead to an investigation of the cause or to a change. They depend on the support and help of guardians or relatives. The prospect of change is only possible in close cooperation with a physician and the patient. Therefore, the consultation of a doctor is necessary already in the first years of life. Once physical growth has been achieved, it can no longer be corrected. Therefore, sufferers of giant growth should develop various strategies that contribute to a fulfilling life as well as a strengthening of the quality of life despite the visual conspicuousness. Mental strength, a stable self-confidence and healthy handling of the physical peculiarities are important to avoid discomfort or psychological disorders in the course of life. If joint complaints occur, rest periods and breaks should be taken in good time. In addition, it is advisable to work with a physiotherapist. Exercises that are specially adapted to the needs of the patient can be performed independently and on a daily basis. They serve to alleviate discomfort and improve overall well-being.
