Background Gigantism is a rare condition where excessive secretion of growth hormone (GH) occurs before fusion of the epiphyseal growth plates. Clinical Case A 23-year-old Sri Lankan male presented to the Endocrine clinic with extreme tall stature, and was diagnosed to have pituitary gigantism. He had been the tallest in his class since 5 years old. Pubertal development from 12 years of age was normal. There was no history of headache, visual disturbance, galactorrhea or any hypogonadal symptoms. Family history was non-contributory. On examination, there were clinical features of frontal bossing, prognathism, and prominence of supra-orbital ridge. He was 196cm in height (calculated midparental height of 171cm) and at Tanner stage 5. Initial medical treatment was started with cabergoline for 1 year, before decision for surgical treatment was sought in Singapore. Initial laboratory investigations revealed an elevated serum insulin-like growth factor-1 (IGF-1) value of 577ng/mL (RR: 116-358ng/mL), and failure of GH suppression during an oral glucose tolerance test, with GH nadir of 3.99 ng/mL (RR: <1 to 13.4ng/mL, no gender nor age-specific cut offs were provided). Prolactin was 132 mIU/L (RR 77-274mIU/L) and total testosterone was 11 nmol/L (RR 5-30nmol/L). Basal cortisol, thyroid function test, and calcium levels were normal. Pituitary magnetic resonance imaging showed a hypo-enhancing focus in the left lateral aspect of the pituitary gland with extension into the sphenoid sinus, measuring 12mm in size at largest diameter, which was suspicious for a pituitary adenoma. He subsequently underwent transphenoidal surgery, and there were no immediate complications post operatively. During a follow up visit 3 months after surgery, laboratory investigations showed normalization of GH (0.33 ng/mL), IGF-1 (212 ng/mL) levels, and normal GH suppression during OGTT. Conclusion Pituitary gigantism occurs during the pre-pubertal period of active linear growth, where elevated GH and IGF-1 levels result in extreme growth acceleration and tall stature (1). The treatment of choice for well-circumscribed pituitary adenomas is transphenoidal surgery, which may be curative (2).