====== Coarse facial features ======
Coarse facial features or coarse facies describes a constellation of facial features that are present in many inborn errors of metabolism.

A 12-year-old girl with a rare plurihormonal pituitary [[macroadenoma]] secreting [[prolactin]] (PRL), [[growth hormone]] (GH), [[Thyroid stimulating hormone]] ([[TSH]]), and [[alpha subunit]] (α-SU).

The patient experienced recurrent [[headache]]s and progressing [[loss of vision]] in one [[eye]]. During the [[examination]], abnormalities such as tall stature, [[coarse facial features]], enlarged feet and hands, tachycardia, hand tremor, hyperhidrosis, galactorrhea, and goiter were observed. Head magnetic resonance imaging (MRI) revealed a solid tumor in the anterior and middle cranial fossa, measuring 80 × 50 × 55 mm. A stereotactic biopsy revealed plurihormonal Pit-1 positive pituitary neuroendocrine tumor secreting PRL, GH, and TSH. A pituitary hyperfunction with PRL, GH, TSH, and α-SU excess was diagnosed. The patient was successfully treated pharmacologically with dopamine agonists and somatostatin analogue, and a decrease of tumor volume (30%) was achieved.

When neurosurgery is not possible, long-term pharmacological treatment of Giant [[plurihormonal pituitary neuroendocrine tumor]] can be a safe and relatively effective alternative
((Moszczyńska E, Grajkowska W, Maksymowicz M, Malicka J, Szalecki M, Prokop-Piotrkowska M. [[Giant plurihormonal pituitary neuroendocrine tumor]] in a [[child]] - [[case study]]. J Pediatr Endocrinol Metab. 2021 Jul 21. doi: 10.1515/jpem-2021-0094. Epub ahead of print. PMID: 34284528.)).