Hyper functioning of Anterior pituitary in pre-pubertal children causes

JIPMER Nursing Officer-2017

Child Health Nursing (Pediatrics)

Easy

Appeared in: JIPMER Nursing Officer-2017

Explanation

Gigantism results from the hypersecretion of Growth Hormone (GH) by the anterior pituitary gland.
This condition specifically occurs in children and adolescents before the fusion of the epiphyseal plates (growth plates) in their long bones.
The key differentiator is the timing of the hormonal excess; 'pre-pubertal' points directly to the period when longitudinal bone growth is still possible, leading to excessive height.

Option B: Acromegaly is caused by excess GH in adults, after the epiphyseal plates have fused. This results in the thickening of bones and soft tissue enlargement, not an increase in height.
Option C: Addison's disease is a condition of primary adrenal insufficiency, meaning the adrenal glands do not produce enough cortisol and aldosterone. It is a state of hypofunction, not hyperfunction of the pituitary.
Option D: Cushing's disease results from a pituitary adenoma that secretes excess Adrenocorticotropic hormone (ACTH), leading to overstimulation of the adrenal cortex and high cortisol levels. While it is a form of pituitary hyperfunction, its signs (e.g., central obesity, moon face) are distinct from the linear growth of gigantism.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Endocrine Disorders: Anterior Pituitary Hyperfunction as background academic context rather than a clinical decision trigger.
Nurses play a vital role in monitoring growth charts for children during routine check-ups. Any significant deviation from the expected growth curve can be an early sign of an endocrine disorder like gigantism, prompting further investigation.
Patient education for families with a child diagnosed with gigantism is crucial. The nurse must explain the treatment plan, which may include surgery, radiation, or medication to control GH levels and prevent long-term complications like cardiovascular disease, diabetes, and joint problems.
What if? If the question specified a 40-year-old adult instead of a pre-pubertal child, the correct answer would be Acromegaly. In adults, the fused epiphyseal plates prevent further increase in height, so the excess GH causes bones to widen and soft tissues to enlarge.

How to Approach the Question

First, break down the question stem. Identify the key elements: 'Hyper functioning of Anterior pituitary' and 'pre-pubertal children'.
Recall the primary hormones of the anterior pituitary, focusing on Growth Hormone (GH) as it is most related to growth.
Connect the hormone (excess GH) with the patient's age ('pre-pubertal'). The term 'pre-pubertal' is a critical clue, indicating that the bone's growth plates (epiphyses) are still open and capable of longitudinal growth.
Evaluate the options based on this understanding:
Gigantism: Caused by excess GH before puberty. This matches the question's parameters.
Acromegaly: Caused by excess GH after puberty. This is the adult counterpart to gigantism.

Concept Tested & Keywords

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E6 Physiology Essentials Sembulingam 10e Part 2 pp. 31-33, 32-34

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 4 p. 10-12