GIGANTISM AND ACROMEGALY THROUGH HISTORY

Abstract

Giants and acromegalists have long captured attention, and they were often almost mythical creatures of great strength and power. Due to their expressive appearance, they were recorded in myths and works of art much earlier than they were of interest to medical practitioners. The first recognition was made by a Dutch physician Johannes Wier in 1567, but the first description and appellation originated by Pierre Marie in 1886. Involvement and interest from neurosurgeons followed, and in 1907, Hermann Schloffer performed the first transsphenoidal surgery in a patient with pituitary adenoma. In 1909, Harvey Cushing linked removal of the enlarged pituitary gland to regression of acromegaly and considered 'growth hormone' a pathophysiological trigger. Knowledge of acromegaly has been enhanced by the discovery of growth hormone (GH) and insulin-like growth factor (IGF-I) and evidence for an association between GH hypersecretion and elevated circulating IGF-I with the clinical phenotype. After 1970, pharmacotherapy (dopamine agonists, somatostatin analogs and GH receptor blockers) was introduced. Despite advances in drug therapy and radiotherapy, surgical treatment still provides optimal results (first-line treatment) after more than a century of attempts. In this paper, we present gigantism and acromegaly over time, important turning points from its recognition to the current insights and fundamental approach reminding us of the immense prosperity of medicine and science. The development of basic sciences and clinical endocrinology will enable progress and improvement of comprehension in the pathogenesis and diagnostics, as well as curative modalities.

Keywords: Acromegaly; Gigantism; Growth hormone; History; Pituitary gland; Pituitary tumors.