Beware of Tall Stature: Growth Hormone Excess Associated with a Rare Parasellar Extra-Axial Tumour-Diagnostic and Management Challenges in a Resource-Limited Setting.
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INTRODUCTION: Tall stature can be the sole indicator of growth hormone (GH) excess, which causes pituitary gigantism before epiphyseal fusion. In developing regions like Indonesia, a lack of systematic screening often delays diagnosis. While classic presentations involve accelerated linear growth, atypical cases may be dominated by neurological signs, such as seizures secondary to tumour mass effect. CASE DESCRIPTION: A 14-year-old boy presented with a 2-year history of rapidly accelerating growth velocity, increasing shoe size, and a 6-month history of severe morning headaches accompanied by drug-resistant focal seizures. Endocrine evaluations revealed significantly elevated basal GH (4.27 ng/ml) and insulin-like growth factor 1 (IGF-1) levels (536 ng/ml). Brain magnetic resonance imaging identified a large parasellar extra-axial tumour with suprasellar extension. The patient underwent a craniotomy and tumour excision; histopathology subsequently confirmed a rare, aggressive malignant mesenchymal tumour. Postoperatively, the patient achieved seizure resolution and normalization of GH and IGF-1 levels. However, he developed evolving pituitary dysfunction consistent with multiple pituitary hormone deficiency (MPHD), specifically central hypothyroidism, necessitating targeted hormonal replacement therapy and continuous clinical follow-up. CONCLUSION: GH excess and gigantism can arise secondary to parasellar pathology rather than intrinsic pituitary disease, with neurological features like refractory epilepsy occasionally preceding classic endocrine manifestations. Rapid adolescent growth paired with neurological signs warrants urgent structural neuroimaging. Meticulous perioperative pituitary monitoring and early multidisciplinary involvement are essential to optimize long-term patient outcomes. LEARNING POINTS: Pituitary gigantism can be driven by extra-axial parasellar masses rather than intrinsic pituitary adenomas, operating via mass-effect compression that disrupts hypothalamic somatostatin inhibition.Drug-resistant epilepsy and severe headaches caused by local tumour infiltration can dominate the clinical picture, meaning rapid adolescent growth paired with neurological symptoms mandates urgent magnetic resonance imaging of the brain.Postoperative multiple pituitary hormone deficiency often evolves silently over weeks or months, requiring lifelong, multidisciplinary surveillance to detect late-stage deficiencies like secondary adrenal insufficiency.