Uporabnik:Melaleuca alternifolia/peskovnik1: Razlika med redakcijama

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Gre za razmeroma redko bolezensko motnjo, ki je posledica zvišanih ravni rastnega hormona v obdobju pred zlitjem rastnega ([[Epifizni hrustanec|epifiznega]]) [[Hrustančevina|hrustanca]]. Stanje se običajno pojavi zaradi nenormalnih izrastlin ([[Tumor|tumorjev]]) na [[Hipofiza|hipofizi]].<ref name=":0">{{Cite journal|last1=Rostomyan|first1=Liliya|last2=Daly|first2=Adrian F.|last3=Petrossians|first3=Patrick|last4=Nachev|first4=Emil|last5=Lila|first5=Anurag R.|last6=Lecoq|first6=Anne-Lise|last7=Lecumberri|first7=Beatriz|last8=Trivellin|first8=Giampaolo|last9=Salvatori|first9=Roberto|date=October 2015|title=Clinical and genetic characterization of pituitary gigantism: an international collaborative study in 208 patients|journal=Endocrine-Related Cancer|volume=22|issue=5|pages=745–757|doi=10.1530/ERC-15-0320|issn=1479-6821|pmid=26187128|pmc=6533620}}</ref><ref name=":1">{{Cite journal|last1=Rostomyan|first1=Liliya|last2=Potorac|first2=Iulia|last3=Beckers|first3=Pablo|last4=Daly|first4=Adrian F.|last5=Beckers|first5=Albert|title=AIP mutations and gigantism|journal=Annales d'Endocrinologie|volume=78|issue=2|pages=123–130|doi=10.1016/j.ando.2017.04.012|pmid=28483363|year=2017}}</ref> Gigantizma se ne sme zamenjevati z [[Akromegalija|akromegalijo]], ki je odrasla različica iste bolezenske motnje, in pri kateri se pojavi povečevanje [[Organ (biologija)|organov]] in akrov (štrlečih oziroma distalnih delov telesa).<ref>{{Cite journal|last1=Chanson|first1=Philippe|last2=Salenave|first2=Sylvie|date=2008-06-25|title=Acromegaly|journal=Orphanet Journal of Rare Diseases|volume=3|pages=17|doi=10.1186/1750-1172-3-17|pmid=18578866|pmc=2459162|issn=1750-1172}}</ref><ref>{{Cite journal|last1=Capatina|first1=Cristina|last2=Wass|first2=John A. H.|date=August 2015|title=60 YEARS OF NEUROENDOCRINOLOGY: Acromegaly|journal=The Journal of Endocrinology|volume=226|issue=2|pages=T141–160|doi=10.1530/JOE-15-0109|issn=1479-6805|pmid=26136383|doi-access=free}}</ref><ref>{{Navedi splet|title=Termania - Slovenski medicinski slovar - akromegalíja|url=https://www.termania.net/slovarji/slovenski-medicinski-slovar/5504847/akromegalija?ld=95&query=akromegalija&SearchIn=Linked|website=www.termania.net|accessdate=2021-06-19}}</ref><ref>{{Navedi knjigo|edition=[1st English ed.]|title=The human body : an introduction to structure and function|url=https://www.worldcat.org/oclc/56415097|publisher=Georg Thieme|date=2004|location=Stuttgart|isbn=978-3-13-129271-1|oclc=56415097|first=Adolf|last=Faller|first2=Gabriele|last2=Schünke|first3=Ethan|last3=Taub}}</ref>
Gre za razmeroma redko bolezensko motnjo, ki je posledica zvišanih ravni rastnega hormona v obdobju pred zlitjem rastnega ([[Epifizni hrustanec|epifiznega]]) [[Hrustančevina|hrustanca]]. Stanje se običajno pojavi zaradi nenormalnih izrastlin ([[Tumor|tumorjev]]) na [[Hipofiza|hipofizi]].<ref name=":0">{{Cite journal|last1=Rostomyan|first1=Liliya|last2=Daly|first2=Adrian F.|last3=Petrossians|first3=Patrick|last4=Nachev|first4=Emil|last5=Lila|first5=Anurag R.|last6=Lecoq|first6=Anne-Lise|last7=Lecumberri|first7=Beatriz|last8=Trivellin|first8=Giampaolo|last9=Salvatori|first9=Roberto|date=October 2015|title=Clinical and genetic characterization of pituitary gigantism: an international collaborative study in 208 patients|journal=Endocrine-Related Cancer|volume=22|issue=5|pages=745–757|doi=10.1530/ERC-15-0320|issn=1479-6821|pmid=26187128|pmc=6533620}}</ref><ref name=":1">{{Cite journal|last1=Rostomyan|first1=Liliya|last2=Potorac|first2=Iulia|last3=Beckers|first3=Pablo|last4=Daly|first4=Adrian F.|last5=Beckers|first5=Albert|title=AIP mutations and gigantism|journal=Annales d'Endocrinologie|volume=78|issue=2|pages=123–130|doi=10.1016/j.ando.2017.04.012|pmid=28483363|year=2017}}</ref> Gigantizma se ne sme zamenjevati z [[Akromegalija|akromegalijo]], ki je odrasla različica iste bolezenske motnje, in pri kateri se pojavi povečevanje [[Organ (biologija)|organov]] in akrov (štrlečih oziroma distalnih delov telesa).<ref>{{Cite journal|last1=Chanson|first1=Philippe|last2=Salenave|first2=Sylvie|date=2008-06-25|title=Acromegaly|journal=Orphanet Journal of Rare Diseases|volume=3|pages=17|doi=10.1186/1750-1172-3-17|pmid=18578866|pmc=2459162|issn=1750-1172}}</ref><ref>{{Cite journal|last1=Capatina|first1=Cristina|last2=Wass|first2=John A. H.|date=August 2015|title=60 YEARS OF NEUROENDOCRINOLOGY: Acromegaly|journal=The Journal of Endocrinology|volume=226|issue=2|pages=T141–160|doi=10.1530/JOE-15-0109|issn=1479-6805|pmid=26136383|doi-access=free}}</ref><ref>{{Navedi splet|title=Termania - Slovenski medicinski slovar - akromegalíja|url=https://www.termania.net/slovarji/slovenski-medicinski-slovar/5504847/akromegalija?ld=95&query=akromegalija&SearchIn=Linked|website=www.termania.net|accessdate=2021-06-19}}</ref><ref>{{Navedi knjigo|edition=[1st English ed.]|title=The human body : an introduction to structure and function|url=https://www.worldcat.org/oclc/56415097|publisher=Georg Thieme|date=2004|location=Stuttgart|isbn=978-3-13-129271-1|oclc=56415097|first=Adolf|last=Faller|first2=Gabriele|last2=Schünke|first3=Ethan|last3=Taub}}</ref>


== Vzork ==
== Vzrok ==
Za gigantizem je značilna pretirana raven rastnega hormona (GH). Slednja je v večini primerov posledica novotvorb hipofize ([[Adenom|adenomov]]).<ref name=":1" /> Adenomi se razvijejo na prednjem režnju hipofize, na tako imenovani [[Adenohipofiza|adenohipofizi]]. Zmožni so tudi povzročitve pretiranega izločanja [[Somatoliberin|somatoliberina]] (GHRH), ki je [[Hipotalamus|hipotalamusni]] prekurzor rastnega hormona.<ref>{{Cite journal|last1=Zimmerman|first1=D|last2=Young|first2=W F|last3=Ebersold|first3=M J|last4=Scheithauer|first4=B W|last5=Kovacs|first5=K|last6=Horvath|first6=E|last7=Whitaker|first7=M D|last8=Eberhardt|first8=N L|last9=Downs|first9=T R|date=1993-01-01|title=Congenital gigantism due to growth hormone-releasing hormone excess and pituitary hyperplasia with adenomatous transformation.|journal=The Journal of Clinical Endocrinology & Metabolism|language=en|volume=76|issue=1|pages=216–222|doi=10.1210/jcem.76.1.8421089|pmid=8421089|issn=0021-972X}}</ref>
Za gigantizem je značilna pretirana raven rastnega hormona (GH). Slednja je v večini primerov posledica novotvorb hipofize ([[Adenom|adenomov]]).<ref name=":1" /> Adenomi se razvijejo na prednjem režnju hipofize, na tako imenovani [[Adenohipofiza|adenohipofizi]]. Zmožni so tudi povzročitve pretiranega izločanja [[Somatoliberin|somatoliberina]] (GHRH), ki je [[Hipotalamus|hipotalamusni]] prekurzor rastnega hormona.<ref>{{Cite journal|last1=Zimmerman|first1=D|last2=Young|first2=W F|last3=Ebersold|first3=M J|last4=Scheithauer|first4=B W|last5=Kovacs|first5=K|last6=Horvath|first6=E|last7=Whitaker|first7=M D|last8=Eberhardt|first8=N L|last9=Downs|first9=T R|date=1993-01-01|title=Congenital gigantism due to growth hormone-releasing hormone excess and pituitary hyperplasia with adenomatous transformation.|journal=The Journal of Clinical Endocrinology & Metabolism|language=en|volume=76|issue=1|pages=216–222|doi=10.1210/jcem.76.1.8421089|pmid=8421089|issn=0021-972X}}</ref>


Redakcija: 14:11, 19. junij 2021

To je peskovnik uporabnika Melaleuca alternifolia. Uporabnikov peskovnik je podstran uporabnikove strani. Služi testiranju in razvijanju strani in ni enciklopedični članek. Ustvari ali uredi svoj lastni peskovnik tukaj (primeren za testiranje z VisualEditorjem).

Drugi peskovniki: Glavni peskovnik | Peskovnik v vadnici 1, 2, 3, 4, 5 | Peskovnik za predloge
Gigantism
SopomenkeGiantism
Robert Wadlow stood 8 ft 11 in (2,72 m)
Specialnostendocrinology
SimptomiAbnormal growth in height or size, weakness and insomnia[1]
ZapletiExcessive sweating, delayed puberty, weakness and severe or recurrent headaches
TrajanjeLifetime
VzrokiHyperplasia in the pituitary gland
ZdravljenjeSurgically remove the enlarged pituitary gland
ZdravilaOctreotide or lanreotide

Gigantizem (grško γίγας, gígas, "velikan", množina γίγαντες, gígantes) je bolezensko stanje, pri katerem je za osebo značilna pretirana rast in telesna višina, ki presega povprečne vrednosti. Pri ljudeh do gigantizma pride zaradi pretiranega nastajanja rastnega hormona (somatotropina[2])[3] v obdobju otroštva, pri čemer tovrstni ljudje dosežejo telesne višine od 2,1 do 2,7 metrov.[4][5][6][7]

Gre za razmeroma redko bolezensko motnjo, ki je posledica zvišanih ravni rastnega hormona v obdobju pred zlitjem rastnega (epifiznega) hrustanca. Stanje se običajno pojavi zaradi nenormalnih izrastlin (tumorjev) na hipofizi.[8][9] Gigantizma se ne sme zamenjevati z akromegalijo, ki je odrasla različica iste bolezenske motnje, in pri kateri se pojavi povečevanje organov in akrov (štrlečih oziroma distalnih delov telesa).[10][11][12][13]

Vzrok

Za gigantizem je značilna pretirana raven rastnega hormona (GH). Slednja je v večini primerov posledica novotvorb hipofize (adenomov).[9] Adenomi se razvijejo na prednjem režnju hipofize, na tako imenovani adenohipofizi. Zmožni so tudi povzročitve pretiranega izločanja somatoliberina (GHRH), ki je hipotalamusni prekurzor rastnega hormona.[14]

Zaradi odvečne količine rastnega hormona otroci z gigantizmom dosežejo nenormalne telesne višine, ki precej presegajo povprečne vrednost.[15] Starost, pri kateri se začnejo kazati jasni znaki gigantizma, je pogosto variabilna, velikokrat pa se to zgodi ob starosti 13 let.[8] Za obolele so značilna tudi druge bolezenske težave, kot je denimo zvišan krvni tlak (hipertenzija). Značilnosti, ki so bolj pogoste za bolnike z akromegalijo, se lahko pojavijo pri pacientih blizu adolescence (mladostniškega obdobja), ki so bližje zlitju rastnega hrustanca.[16]

Hormonal cause

Growth hormone (GH) and insulin-like growth factor-I (IGF-I) are two substances that have been identified as influencing growth plate formation and bone growth and, therefore, gigantism. Their specific mechanisms are still not well understood.[8][17]

More broadly, GH and IGF have both been identified to be involved in most stages of growth: embryonic, prenatal, and postnatal.[18][19] Moreover, the receptor gene for IGF has been shown to be particularly influential throughout various stages of development, especially prenatally. This is the same for GH receptor genes which have been known to drive overall growth throughout various pathways.[18][20]

Growth hormone is a precursor (upstream) of IGF-I, but each has its independent role in hormonal pathways. Yet both seem to ultimately come together to have a joint effect on growth.[19]

Diagnostic testing

Evaluation of growth hormone hyper-secretion cannot be excluded with a single normal GH level due to diurnal variation. However, a random blood sample showing markedly elevated GH is adequate for diagnosis of GH hyper-secretion. Additionally, a high-normal GH level that fails to suppress with administration of glucose is also sufficient for a diagnosis of GH hyper-secretion.[21]

Insulin-like growth factor-1 (IGF-1) is an excellent test for evaluation of GH hyper-secretion. It does not undergo diurnal variation and will thus be consistently elevated in GH hyper-secretion and therefore patients with gigantism. A single normal IGF-1 value will reliably exclude GH hyper-secretion.[21]

Genetic

Finding a specific genetic cause for gigantism has proven to be difficult. Gigantism is the primary example of growth hormone hyper-secretion disorders, a group of illnesses that are not yet deeply understood.[8]

Some common mutations have been associated with gigantism. Pediatric gigantism patients have shown to have duplications of genes on a specific chromosome, Xq26. Typically, these patients also experienced an onset of typical gigantism symptoms before reaching the age of 5. This indicates a possible linkage between gene duplications and the gigantism.[22]

Additionally, DNA mutations in the aryl hydrocarbon receptor interacting protein (AIP) gene are common in gigantism patients. They have been found to be present in about 29 percent of patients with gigantism.[9] AIP is labeled as a tumor suppressor gene and a pituitary adenoma disposition gene.[9][23]

Mutations in AIP sequencing can have deleterious effects by inducing the development of pituitary adenomas which in turn can cause gigantism.[9][23]

Two specific mutations in the AIP gene have been identified as possible causes of pituitary adenomas. These mutations also have the ability to cause adenoma growth to occur early in life.[24] This is typical in gigantism.

Additionally, a large variety of other known genetic disorders have been found to influence the development of gigantism such as multiple endocrine neoplasia type 1 and 4, McCune-Albright syndrome, Carney complex, familial isolated pituitary adenoma, X-linked acrogigantism (X-LAG).[9][25]

Although various gene mutations have been associated with gigantism, over 50 percent of cases cannot be linked to genetic causes, showing the complex nature of the disorder.[8]

Treatment

Many treatments for gigantism receive criticism and are not accepted as ideal. Various treatments involving surgery and drugs have been used to treat gigantism.[26]

Pharmaceuticals

Pegvisomant is one pharmaceutical drug which has received attention for being a possible treatment route for gigantism. Reduction of the levels of IGF-I as a result of pegvisomant administration can be incredibly beneficial for the pediatric gigantism patients.[26]

After treatment with pegvisomant, high growth rates, a feature characteristic of gigantism, can be significantly decreased.[26] Pegvisomant has been seen to be a powerful alternative to other treatments such as somatostatin analogues, a common treatment method for acromegaly, if drug treatment is paired with radiation.[27]

Finding the optimal level of pegvisomant is important so normal body growth is not negatively affected. In order to do this, titration of the medication can be used as a way to find the proper administration level.[26]

See acromegaly for additional treatment possibilities.

Terminology

Daniel Cajanus (1704–1749), a Finnish giant.
André the Giant, a wrestler and actor in The Princess Bride.
Giantess Anna Swan with her parents.

The term is typically applied to those whose height is not just in the upper 1% of the population but several standard deviations above mean for persons of the same sex, age, and ethnic ancestry. The term is seldom applied to those who are simply "tall" or "above average" whose heights appear to be the healthy result of normal genetics and nutrition. Gigantism is usually caused by a tumor on the pituitary gland of the brain. It causes growth of the hands, face, and feet.[28][potreben boljši vir] In some cases the condition can be passed on genetically through a mutated gene.[29]

Other names somewhat obsolete for this pathology are hypersoma (Greek: hyper over the normal level; soma body) and somatomegaly (Greek; soma body, genitive somatos of the body; megas, gen. megalou great). In the past, while many of them were social outcasts because of their height, some (usually unintentionally) found employment in Friedrich Wilhelm I's famous Potsdam Giants regiment.

Many of those who have been identified with gigantism have suffered from multiple health problems involving the circulatory or skeletal system, as the strain of maintaining a large, heavy body places abnormal demands on both the bones and the heart.

Society and culture

Glavni članek: Giant (mythology).

Reports of gigantism exist throughout history, with some nations and tribes taller than others. The giants of Crete are listed in various historic sources, beginning with Titan, a Greek mythological giant, and including Gigantus, after whom giants and gigantism are named. Rhodes is another island where giants were said to have lived, with the Colossus of Rhodes, a giant statue of a giant patron god Helios. Goliath, a giant mentioned in the Bible, was a Philistine warrior who was killed by David in the war between the Israelites and the Philistines. A member of Goliath's family is also described as having six digits on each hand and each foot.[30]

Glej tudi

Sklici

  1. ↑ What causes gigantism?-healthline
  2. ↑ »Termania - Slovenski medicinski slovar - somatotropín«. www.termania.net. Pridobljeno 19. junija 2021.
  3. ↑ Gigantismv Dorland's Medical Dictionary
  4. ↑ »Gigantism | UCLA Pituitary Tumor Program«. pituitary.ucla.edu. Pridobljeno 27. aprila 2017.
  5. ↑ »Gigantism: MedlinePlus Medical Encyclopedia«. medlineplus.gov (v angleščini). Pridobljeno 27. aprila 2017.
  6. ↑ »Gigantism and Acromegaly: Practice Essentials, Background, Pathophysiology and Etiology«. 7. januar 2017. {{navedi časopis}}: Sklic journal potrebuje|journal= (pomoč)
  7. ↑ »Gigantism and Acromegaly - Hormonal and Metabolic Disorders - MSD Manual Consumer Version«. MSD Manual Consumer Version (v angleščini). Pridobljeno 27. aprila 2017.
  8. ↑ 8,0 8,1 8,2 8,3 8,4 Rostomyan, Liliya; Daly, Adrian F.; Petrossians, Patrick; Nachev, Emil; Lila, Anurag R.; Lecoq, Anne-Lise; Lecumberri, Beatriz; Trivellin, Giampaolo; Salvatori, Roberto (Oktober 2015). »Clinical and genetic characterization of pituitary gigantism: an international collaborative study in 208 patients«. Endocrine-Related Cancer. 22 (5): 745–757. doi:10.1530/ERC-15-0320. ISSN 1479-6821. PMC 6533620. PMID 26187128.
  9. ↑ 9,0 9,1 9,2 9,3 9,4 9,5 Rostomyan, Liliya; Potorac, Iulia; Beckers, Pablo; Daly, Adrian F.; Beckers, Albert (2017). »AIP mutations and gigantism«. Annales d'Endocrinologie. 78 (2): 123–130. doi:10.1016/j.ando.2017.04.012. PMID 28483363.
  10. ↑ Chanson, Philippe; Salenave, Sylvie (25. junij 2008). »Acromegaly«. Orphanet Journal of Rare Diseases. 3: 17. doi:10.1186/1750-1172-3-17. ISSN 1750-1172. PMC 2459162. PMID 18578866.
  11. ↑ Capatina, Cristina; Wass, John A. H. (Avgust 2015). »60 YEARS OF NEUROENDOCRINOLOGY: Acromegaly«. The Journal of Endocrinology. 226 (2): T141–160. doi:10.1530/JOE-15-0109. ISSN 1479-6805. PMID 26136383.
  12. ↑ »Termania - Slovenski medicinski slovar - akromegalíja«. www.termania.net. Pridobljeno 19. junija 2021.
  13. ↑ Faller, Adolf; Schünke, Gabriele; Taub, Ethan (2004). The human body : an introduction to structure and function ([1st English ed.] izd.). Stuttgart: Georg Thieme. ISBN 978-3-13-129271-1. OCLC 56415097.
  14. ↑ Zimmerman, D; Young, W F; Ebersold, M J; Scheithauer, B W; Kovacs, K; Horvath, E; Whitaker, M D; Eberhardt, N L; Downs, T R (1. januar 1993). »Congenital gigantism due to growth hormone-releasing hormone excess and pituitary hyperplasia with adenomatous transformation«. The Journal of Clinical Endocrinology & Metabolism (v angleščini). 76 (1): 216–222. doi:10.1210/jcem.76.1.8421089. ISSN 0021-972X. PMID 8421089.
  15. ↑ Eugster, Erica A.; Pescovitz, Ora H. (1. december 1999). »Gigantism«. The Journal of Clinical Endocrinology & Metabolism. 84 (12): 4379–4384. doi:10.1210/jcem.84.12.6222. ISSN 0021-972X. PMID 10599691.
  16. ↑ Murray, P. G.; Clayton, P. E. (2000). »Disorders of Growth Hormone in Childhood«. V De Groot, Leslie J.; Chrousos, George; Dungan, Kathleen; Feingold, Kenneth R.; Grossman, Ashley; Hershman, Jerome M.; Koch, Christian; Korbonits, Márta; McLachlan, Robert (ur.). Endotext. South Dartmouth (MA): MDText.com, Inc. PMID 25905205.
  17. ↑ Shim, Kye Shik (Marec 2015). »Pubertal growth and epiphyseal fusion«. Annals of Pediatric Endocrinology & Metabolism. 20 (1): 8–12. doi:10.6065/apem.2015.20.1.8. ISSN 2287-1012. PMC 4397276. PMID 25883921.
  18. ↑ 18,0 18,1 Laron, Z (Oktober 2001). »Insulin-like growth factor 1 (IGF-1): a growth hormone«. Molecular Pathology. 54 (5): 311–316. doi:10.1136/mp.54.5.311. ISSN 1366-8714. PMC 1187088. PMID 11577173.
  19. ↑ 19,0 19,1 Lupu, Floria; Terwilliger, Joseph D.; Lee, Kaechoong; Segre, Gino V.; Efstratiadis, Argiris (2001). »Roles of growth hormone and insulin-like growth factor 1 in mouse postnatal growth«. Developmental Biology. 229 (1): 141–162. doi:10.1006/dbio.2000.9975. PMID 11133160.
  20. ↑ Sanders, Esmond J.; Harvey, Steve (2004). »Growth hormone as an early embryonic growth and differentiation factor«. Anatomy and Embryology. 209 (1): 1–9. doi:10.1007/s00429-004-0422-1. PMID 15480774. S2CID 19528310.
  21. ↑ 21,0 21,1 De Mais, Daniel. ASCP Quick Compendium of Clinical Pathology, 2nd Ed. ASCP Press, Chicago, 2009.
  22. ↑ Trivellin, Giampaolo; Daly, Adrian F.; Faucz, Fabio R.; Yuan, Bo; Rostomyan, Liliya; Larco, Darwin O.; Schernthaner-Reiter, Marie Helene; Szarek, Eva; Leal, Letícia F. (2014). »Gigantism and Acromegaly Due to Xq26 Microduplications and GPR101 Mutation«. New England Journal of Medicine. 371 (25): 2363–2374. doi:10.1056/nejmoa1408028. PMC 4291174. PMID 25470569.
  23. ↑ 23,0 23,1 Beckers, Albert; Aaltonen, Lauri A.; Daly, Adrian F.; Karhu, Auli (1. april 2013). »Familial Isolated Pituitary Adenomas (FIPA) and the Pituitary Adenoma Predisposition due to Mutations in the Aryl Hydrocarbon Receptor Interacting Protein (AIP) Gene«. Endocrine Reviews. 34 (2): 239–277. doi:10.1210/er.2012-1013. ISSN 0163-769X. PMC 3610678. PMID 23371967.
  24. ↑ Vierimaa, Outi; Georgitsi, Marianthi; Lehtonen, Rainer; Vahteristo, Pia; Kokko, Antti; Raitila, Anniina; Tuppurainen, Karoliina; Ebeling, Tapani M. L.; Salmela, Pasi I. (26. maj 2006). »Pituitary Adenoma Predisposition Caused by Germline Mutations in the AIP Gene«. Science (v angleščini). 312 (5777): 1228–1230. Bibcode:2006Sci...312.1228V. doi:10.1126/science.1126100. ISSN 0036-8075. PMID 16728643. S2CID 37013760.
  25. ↑ Rostomyan, Liliya; Daly, Adrian F.; Beckers, Albert (2015). »Pituitary gigantism: Causes and clinical characteristics«. Annales d'Endocrinologie. 76 (6): 643–649. doi:10.1016/j.ando.2015.10.002. PMID 26585365.
  26. ↑ 26,0 26,1 26,2 26,3 Goldenberg, Naila; Racine, Michael S.; Thomas, Pamela; Degnan, Bernard; Chandler, William; Barkan, Ariel (1. avgust 2008). »Treatment of Pituitary Gigantism with the Growth Hormone Receptor Antagonist Pegvisomant«. The Journal of Clinical Endocrinology & Metabolism. 93 (8): 2953–2956. doi:10.1210/jc.2007-2283. ISSN 0021-972X. PMC 2515082. PMID 18492755.
  27. ↑ Rix, M.; Laurberg, P.; Hoejberg, A. S.; Brock-Jacobsen, B. (1. avgust 2005). »Pegvisomant therapy in pituitary gigantism: successful treatment in a 12-year-old girl«. European Journal of Endocrinology (v angleščini). 153 (2): 195–201. doi:10.1530/eje.1.01956. ISSN 0804-4643. PMID 16061823.
  28. ↑ »Gigantism«. Question.com. Arhivirano iz prvotnega spletišča dne 13. marca 2012. Pridobljeno 14. marca 2012.
  29. ↑ In a Giant’s Story, a New Chapter Writ by His DNA - By Gina Kolata. The New York Times, January 5, 2011
  30. ↑ Story of Goliath in Predloga:Bibleref2 – 6 fingers in Predloga:Bibleverse cf. Predloga:Bibleref2
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