A History of Acromegaly

Abstract

Legendary giants described in the ancient scriptures were said to be of tremendous stature and mighty in war. King Og of Bashan was said to be so tall that he could roast a ~sh by holding it at arms length towards the sun. A history of acromegaly without these wonderfully vivid stories of gigantism would be incomplete although eventually we will have to spoil the fun and call for the measurements to be scienti~cally validated. Anthropometric data on giants, even during Cushing’s era, were often proved later to be innacurate [1]. This is perhaps no better illustrated than by the tales of the Persian giant presented to the American Medical Association in 1935. This giant, although extremely sick and said to be over ten feet tall, was con~rmed at post mortem one year later to have ‘shrunk’ by three feet and was in fact only about seven feet tall. Returning brie_y to the ancient scriptures, the killing of Goliath by David possibly represents the ~rst account of the physical disadvantage caused by a large pituitary tumour. Imagine the Philistines ready for battle on one hilltop and the Israelites on the other. The giant, Goliath, strode out of the philistine camp and towering above everyone, bellowed out a challenge to Saul to send one of his men to ~ght him. David stepped forward, refusing all weapons and armour, he went to a nearby stream where he picked out ~ve pebbles. As Goliath was still mocking his boy opponent, David crept up within the visual ~eld defect of his victim. David placed a pebble in his sling and after whirling it around once, let the stone _y towards the unsuspecting giant who was struck in the middle of his forehead and crashed down dead. The Philistines on seeing their war hero dead turned and ran leaving the Israelites to celebrate their victory. Any interpretation regarding Goliath’s downfall being the result of chiasmal compression by a suprasellar pituitary tumour could only be conceived this century since it is only during this time that pituitary disease has been recognised. Goliath’s acromegalic appearance, however, may well have been in the minds of storytellers over many centuries and this certainly appears to have been entertained by the French painter Pierre Puget when he painted ‘David, vainqueur de Goliath’ (Figure 1). Currently exhibited in Quebec, this picture shows Goliath with the typical facial features of acromegaly, a point remarkable for the timing of the painting being more than one hundred years before Marie originally described the condition in 1886. Tales of giants in history do sometimes reveal what we now know to be true, that despite their excessive size, acromegalic giants are characteristically weak. The clinical features so classically described in Pierre Marie’s 1886 thesis marked the beginning of the study of pituitary disease although Marie himself did not directly implicate the pituitary as having a causal role in the condition. Up until that time little was known about the function of the glandular structures of the body and for many centuries the pituitary was thought of as an unimportant vestigial remnant whose function was to produce the rather uninspiring contents of nasal mucous [2]. The medical philosophies attributed to the ancient Greeks and Romans dominated medical practice in Europe for many centuries and partly explains why the function of the pituitary was so profoundly misinterpreted for so long. The fact that little progress in medicine was made during the 1000 or so years of the Byzantine empire (395 B.C.–1453 A.D.) is also relevant. Signi~cant advances in science only appeared at the time of the Renaissance and endocrinology as a discipline did not evolve until experimental medicine was introduced in the 19th century. The founding father of this new style of scienti~c medicine was Claude Bernard who proposed that ‘internal secretions’ affected the body after entering the bloodstream from glandular structures [3]. It is only after considering this gradual evolution of scienti~c thought that can we appreciate why, having so classically described the clinical features of acromegaly, Marie failed to appreciate the role of the pituitary in causing the disorder.

DOI: 10.1023/A:1009913719680

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Cite this paper

@article{Sheaves1999AHO, title={A History of Acromegaly}, author={Richard Sheaves}, journal={Pituitary}, year={1999}, volume={2}, pages={7-28} }