An early scientific report on acromegaly: solving an intriguing endocrinological (c)old case?

We present and discuss a late-nineteenth century clinical case described by Professor Taruffi in a scientific paper titled "Scheletro con prosopoectasia e tredici vertebre dorsali" (Skeleton with prosopoectasia and thirteen thoracic vertebrae). Taruffi could not explain the disproportionate skeletal and visceral growth, and the case could therefore be considered an unrecognized case of acromegaly. The anatomopathological specimens and the wax model cited in the paper are currently hosted at the "Luigi Cattaneo" Anatomical Wax Collection of Bologna University; however, some inaccuracies and uncertainties as to their attribution to the same case have remained to this day. The skeletal remains were examined macroscopically to investigate any structural abnormalities and pathological changes. In addition, thanks to archival, museum inventory and literature research, we documented the systematic relationship between the paper and the samples and were able to ascribe the abnormally dilated dried stomach, currently displayed in a different showcase, to the same case. This is, to our knowledge, the first case of acromegaly in the history of medical literature which also includes a visceral specimen. As far as we know, there are no reports of the occurrence of severe gastromegaly in patients with acromegaly. In view of this rare association and, to date, endocrinological research, we hypothesize a further pathogenic mechanism by which acromegaly could have induced this massive dilatation. Taruffi's work represents an immensely valuable scientific/artistic heritage and is still cited in contemporary endocrinological literature, demonstrating its relevant contribution to the historical evolution of the disease through the nineteenth and twentieth centuries.

From dwarves to giants: South American's contribution to the history of growth hormone and related disorders

The aim of this article is to present a historical review on giants and dwarves living in South America and the contribution of South America's researchers to scientific advances on growth hormone (GH) and human disorders related to GH excess and GH deficiency (GHD). We went back in time to investigate facts and myths stemming from countless reports of giants who lived in the Patagonia region, focusing on what is currently known about gigantism in South America. Additionally, we have reviewed the exceptional work carried out in two of the world's largest cohorts of dwarfism related to GH-IGF axis: one living in Itabaianinha, Brazil, suffering from severe GHD due to a mutation in the GHRH receptor (GHRHR) gene, and the other living in El Oro and Loja provinces of Ecuador, who are carriers of GH receptor gene mutation that causes total GH insensitivity (Laron syndrome). Importantly, we present an overview of the outstanding medical contribution of Jose Dantas de Souza Leite, a Brazilian physician that described the first cases of acromegaly, and Bernardo Alberto Houssay, an Argentine researcher graced with the Nobel Prize, who was one the first scientists to establish a link between GH and glucose metabolism.

"The giant Hans Kraus" (1553): a Renaissance acromegaly by anonymous painter

The Wunderkammer of Schloss Ambras in Innsbruck was one of the first cabinets of curiosities, created in the sixteenth century. Among the many curiosities, the cabinet includes an anonymous Renaissance painting called "Der Riese Hans Kraus" (The giant Hans Kraus). The details suggest us that it could be a representation of an individual affected by acromegaly.

ANNIVERSARY REVIEW: 50 years since the discovery of bromocriptine

Ergotism is the long-term ergot poisoning by ingestion of rye or other grains infected with the fungus Claviceps purpurea and more recently by excessive intake of ergot drugs. It has either neuropsychiatric or vascular manifestations. In the Middle Ages, the gangrenous poisoning was known as St. Anthony's fire, after the order of the Monks of St. Anthony who were particularly skilled at treating the condition. In 1917, Prof. Arthur Stoll returned home to Switzerland from Germany, to lead the development of a new pharmaceutical department at Sandoz Chemical Company. Stoll, using the special methods of extraction learned from his work with his mentor Willstetter, started his industrial research work with ergot. He succeeded in isolating, from the ergot of rye, ergotamine as an active principle of an old popular remedy for excessive post-partum bleeding. The success of this discovery occurred in 1918 and was translated into a pharmaceutical product in 1921 under the trade name Gynergen. In subsequent work, Stoll and his team were leaders in identifying the structure of the many other alkaloids and amines produced by Claviceps purpurea This was the cultural background and scientific foundation on which bromocriptine was discovered.

The Oldest Recorded Case of Acromegaly and Gigantism in Iran

Here we commemorate the character and academic authority of Prof. Zabiholah Gorban (1903-2006), the founder of Shiraz medical school. No doubt, in the scope of history of contemporary medicine, he has been efficient and effective. With respect to this fact, his article on a rare case described in Acta anatomica published in Iran in 1966, entitled (Observations on a giant skeleton) is browsed and reviewed. A case named Siah Khan with combined acromegaly and gigantism that appears to have letters to say still after nearly half a century.

Acromegalic gigantism, physicians and body snatching. Past or present?

The skeletons of 2 famous acromegalic giants: Charles Byrne (1761-1783) and Henri Cot = Joseph Dusorc (1883-1912) and the embalmed body of the famous acromegalic giant Édouard Beaupré (1881-1904) all ended up in the medical collections of museums despite the fact that these patients had never donated or even refused to donate their corpses, nor had their relatives given permission. The corpse of the acromegalic giant John Aasen (1890-1938) was voluntarily donated to a physician annex collector of trivia from acromegalic giants. The autopsy on the acromegalic giant John Turner (1874-1911) was performed during his funeral ceremony without the relatives being informed. Only recently, the acromegalic giant Alexander Sizonenko (1959-2012) was made a financial offer during his life in exchange for his body after his death. The case-histories of these 6 patients and also the circumstances that led to the (in-) voluntary donation of their bodies are reviewed.

Familial gigantism

Familial GH-secreting tumors are seen in association with three separate hereditary clinical syndromes: multiple endocrine neoplasia type 1, Carney complex, and familial isolated pituitary adenomas.

A case of acromegaly (Greece, 7th century AD)

OBJECTIVE

To diagnose hormone-secreting pituitary adenoma in dry bones.

DESIGN

We present here the case of a pathological skull from the Byzantine site of Eleutherna (Greece).

METHODS

A complete anthropological and medical examination of the skull and the whole conserved skeleton was performed in the laboratory.

RESULTS

All anatomical signs of acromegaly were present on this skull. More importantly, enlargement of the sella turcica clearly indicated the development of a macroadenoma, at the origin of the disease.

CONCLUSIONS

This skeletal case, and other ancient ones are discussed, to better describe the history of the disease, and the possibilities of the diagnosis.

AIP mutation in pituitary adenomas in the 18th century and today

Gigantism results when a growth hormone-secreting pituitary adenoma is present before epiphyseal fusion. In 1909, when Harvey Cushing examined the skeleton of an Irish patient who lived from 1761 to 1783, he noted an enlarged pituitary fossa. We extracted DNA from the patient's teeth and identified a germline mutation in the aryl hydrocarbon-interacting protein gene (AIP). Four contemporary Northern Irish families who presented with gigantism, acromegaly, or prolactinoma have the same mutation and haplotype associated with the mutated gene. Using coalescent theory, we infer that these persons share a common ancestor who lived about 57 to 66 generations earlier.

Acromegaly and gigantism in the medical literature. Case descriptions in the era before and the early years after the initial publication of Pierre Marie (1886)

In 1886 Pierre Marie used the term "acromegaly" for the first time and gave a full description of the characteristic clinical picture. However several others had already given clear clinical descriptions before him and sometimes had given the disease other names. After 1886, it gradually became clear that pituitary enlargement (caused by a pituitary adenoma) was the cause and not the consequence of acromegaly, as initially thought. Pituitary adenomas could be found in the great majority of cases. It also became clear that acromegaly and gigantism were the same disease but occurring at different stages of life and not different diseases as initially thought. At the end of the 19th and beginning of the 20th century most information was derived from case descriptions and post-mortem examinations of patients with acromegaly or (famous) patients with gigantism. The stage was set for further research into the pathogenesis, diagnosis and therapy of acromegaly and gigantism.

[Acromegaly--from myths to facts]

The authors present numerous historical descriptions of persons who might suffered from gigantism or acromegaly. The oldest medical data of patients, initial attempts of causal neurosurgical treatment, history of growth hormone, insulin-like growth factor-1, growth hormone releasing hormone and somatostatin discovery is reported. The highest contemporary living persons are also listed.

Sellar region surgery in Croatia in the first half of 20th century

We reconstructed the historical development of surgical approaches to the pituitary gland, which were used in Croatia in the first half of the 20th century, on the basis of earliest clinical case reports and descriptions of initial surgical attempts. The first published case report on surgical treatment of acromegaly was described, as well as the review of 11 patients with pituitary disease admitted to the Ophthalmology Clinic in Zagreb in the period 1925-1927. The earliest 5 reports on pituitary surgery dating from 1925 were analyzed to reveal the circumstances that led to the development of transsphenoidal approach as a method of choice in Croatia, when this technique was becoming obsolete in other parts of the world. Frequent modifications of surgical approaches to sellar region have been shown a suitable historical-medical model for analysis of changes in surgical trends.

[Henry IV of Castilla (1454-1474). An exceptional urologic patient. An endocrinopathy causing the uro-andrological problems of the Monarch. Chronic renal lithiasis (II)]

OBJECTIVES

To review all known data about the endocrinopathy and renal disease suffered by Henry IV of Castile according to contemporary chronicles and manuscripts, comparing the clinical diagnosis made by Gregorio Marañon 70 years ago in his work "Biological essay about Henry IV and his time" (Madrid 1930) with present concepts, because we consider, as other medical authors, that his endocrinopathy is not well determined. Regarding his chronic renal lithiasis, it could have played an important role as negative factor in the Monarch's quality of life, and have been related to his endocrinopathy, so that it should also be reviewed.

METHODS

We reviewed a total of 10 chronicles and 5 contemporary manuscripts treating the look and diseases of Henry IV to obtain the most important data about both diseases and be able to characterize the kind of endocrine disease suffered by the Monarch, and all aspects regarding his lithiasis, and compare them with our current knowledge.

RESULTS

From the review of those chronicles and manuscripts, it is my opinion that Henry IV suffered acromegaly secondary to a GH and prolactine producing hypophyseal tumor from childhood, which might justify the impotence he suffered from his youth and other symptoms clearly referred in the chronicles. Chronic renal lithiasis (flank pain, lumbar illness, and hematuria) finally led to acute obstructive uropathy, main cause of his death. This fact has not been emphasized by historians. The renal lithiasis benign part of a multiple endocrine neoplasia syndrome (MEN I) can not be ruled out.

[Acromegaly: a disorder with distinguished features yet delayed diagnosis]

The authors review the historical and epidemiological aspects, as well as the distinguishing clinical features and complications of acromegaly to emphasize the importance of early diagnosis and treatment of patients with this disorder. Acromegaly is a rare disorder with a prevalence of 55-69 cases per million population and an incidence of 3-4 newly detected cases per million per year. Recent estimates indicate, that its slow progression and insidious course leads to a considerable time lag of 7-12 years between the first symptoms and the diagnosis of the disease, although younger patients with more severe disease may be detected earlier. In addition to the disfigurement and disability which develop progressively from the onset of the disease, acromegaly is associated with a number of complications resulting in a two- or three-fold increase of mortality and a decrease of life expectancy by about 10 years. The major causes of death include cardiovascular and cerebrovascular events, respiratory disease and malignancy. Because the duration of the disease before effective therapy may be one of the major predictors of increased mortality, practicing doctors need to be particularly vigilant to recognize undiagnosed cases in order to avoid the serious complications of the disease.

Acromegaly: historical perspectives and current therapy

Soon after the initial description of acromegaly in the late 19th century, neurosurgeons performed the first operative procedures for the disease. Transcranial procedures eventually yielded to the transsphenoidal approach. Reasonably effective medical therapy was introduced in the 1970s and pharmacological progress continues to be realized. It is now recognized that excess growth hormone is associated with significant morbidity and mortality and that biochemical remission improves outcome. Although medical and radiation treatments offer useful adjuncts, surgery provides optimal results.

[Akhenaton--pharaoh and heretic]

Akhenaten has been called the first individualist in history. As the eldest son of the pharaoh Amenhotep III and queen Tiy he grew up between a weak and sick father and an ambitious and intelligent mother at a time when Egypt was at the peak of its power. At court they led a life in luxury; however, the pharaoh went out hunting while his wife was ruling the strongest empire of the ancient world. The gifted young pharaoh to be was a philosopher with great interests in the arts. He took over his parents' scepticism against the powerful priesthood. Later, as Akhenaten, he created a monotheistic religion with a good-natured God symbolized by the disc of the life-giving sun. He appointed himself high priest, thus dethroning the numerous priests serving the many animal-shaped gods of ancient Egypt. His introduction of one single deity might, from a psychoanalytic point of view, be interpreted as an extension of his needs for a warm mother. The physiognomy of Akhenaten was peculiar; statues of him convey the impression of a man with acromegaly. His reluctance in defending the borders of his country was perhaps also a result of an endocrine development, making him lethargic.

Dwarfism and gigantism in historical picture postcards

A collection of 893 historical picture postcards from 1900 to 1935, depicting dwarfs and giants, was analysed from medical and psychosocial viewpoints. In conditions such as 'bird headed dwarfism', achondroplasia, cretinism, so-called Aztecs or pinheads, Grebe chondrodysplasia, and acromegalic gigantism, the disorder could be diagnosed easily. In hypopituitary dwarfism, exact diagnosis was more difficult because of heterogeneity. The most common conditions depicted were pituitary dwarfism and achondroplasia. Most of those with gigantism had pituitary gigantism and acromegaly. Brothers and sisters or parents and their children provided evidence of mendelian inheritance of some of these disorders. The cards suggest that being put on show provided, at least in some cases, social benefits.

Acromegaly, Mr Punch and caricature

The origin of Mr Punch from the Italian Pulcinella of the Commedia dell'arte is well known but his feature, large hooked nose, protruding chin, kyphosis and sternal protrusion all in an exaggerated form also suggest the caricature of an acromegalic. This paper looks at the physical characteristics of acromegaly, the origin of Mr Punch and the development of caricature linking them together in the acromegalic caricature that now has a life of its own.