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Governor Pio Pico, the monster of California...no more: lessons in neuroendocrinology.

Login IS, Login J - Pituitary (2010)

Bottom Line: Pearce Bailey published the first account of pituitary tumor infarction only in 1898.Pico's undiagnosed, misunderstood, profoundly acromegalic appearance was widely misinterpreted, leading to pervasive, degrading, and highly prejudicial comments.This landmark case study in neuroendocrinology provides the opportunity to re-examine elements of 19th century California and American history.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, University of Virginia School of Medicine, Box 800394, Charlottesville, VA, 22908, USA. isl@hscmail.mcc.virginia.edu

ABSTRACT
We hypothesize that Pio Pico, the last Mexican Governor of California, had acromegaly between at least ages 43 to 57, from 1844 to 1858, before Pierre Marie published the clinical description of acromegaly in 1886. Pico's probable growth hormone-secreting pituitary tumor likely infarcted spontaneously after 1858. The tumor infarction resulted in burnt-out acromegaly and probably restored normal pituitary function. Pearce Bailey published the first account of pituitary tumor infarction only in 1898. Pico's undiagnosed, misunderstood, profoundly acromegalic appearance was widely misinterpreted, leading to pervasive, degrading, and highly prejudicial comments. This landmark case study in neuroendocrinology provides the opportunity to re-examine elements of 19th century California and American history.

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Pio Pico has striking clinical features of acromegaly in 1858 about 4 years after the death of his wife, Maria Ignacia. The left ocular globe is mildly proptotic and located eccentrically in the orbit compatible with tumor extension into the left cavernous sinus and orbit. Note the marked asymmetry of the location of the light reflection in each eye. We are unable to assess pupillary size. His hairless face could reflect secondary hypogonadism. The enlarged inset emphasizes his dysconjugate gaze and the loss of lateral eyebrows (compare with Fig. 1) suggesting hypothyroidism. At this point in his life he was a successful rancher, businessman, and landowner. Courtesy of the Bancroft Library, University of California at Berkeley
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Fig4: Pio Pico has striking clinical features of acromegaly in 1858 about 4 years after the death of his wife, Maria Ignacia. The left ocular globe is mildly proptotic and located eccentrically in the orbit compatible with tumor extension into the left cavernous sinus and orbit. Note the marked asymmetry of the location of the light reflection in each eye. We are unable to assess pupillary size. His hairless face could reflect secondary hypogonadism. The enlarged inset emphasizes his dysconjugate gaze and the loss of lateral eyebrows (compare with Fig. 1) suggesting hypothyroidism. At this point in his life he was a successful rancher, businessman, and landowner. Courtesy of the Bancroft Library, University of California at Berkeley

Mentions: Unregulated GH release most commonly arises from an anterior pituitary GH-secreting adenoma. Pio Pico exhibits three manifestations of his tumor. First, he persuasively demonstrates the systemic effects of GH excess (Fig. 1). Second, he has dysconjugate gaze (Fig. 1, inset). With a presumed pituitary adenoma this sign implies lateral growth from the sella turcica into the adjacent cavernous sinus. In 1858 he appears more acromegalic, but now with striking left eye displacement and slight proptosis (Fig. 4). Third, he has apparent secondary thyrotropin deficiency manifesting as the loss of lateral eyebrows [4] and, at least by history (see below), possible secondary hypogonadism, each of which can result from mass effect of his presumed GH-secreting tumor on the adjacent normal pituitary (Fig. 4). Up to 30% of GH-secreting pituitary tumors also produce excess prolactin [5] which can independently inhibit gonadotropin function.Fig. 4


Governor Pio Pico, the monster of California...no more: lessons in neuroendocrinology.

Login IS, Login J - Pituitary (2010)

Pio Pico has striking clinical features of acromegaly in 1858 about 4 years after the death of his wife, Maria Ignacia. The left ocular globe is mildly proptotic and located eccentrically in the orbit compatible with tumor extension into the left cavernous sinus and orbit. Note the marked asymmetry of the location of the light reflection in each eye. We are unable to assess pupillary size. His hairless face could reflect secondary hypogonadism. The enlarged inset emphasizes his dysconjugate gaze and the loss of lateral eyebrows (compare with Fig. 1) suggesting hypothyroidism. At this point in his life he was a successful rancher, businessman, and landowner. Courtesy of the Bancroft Library, University of California at Berkeley
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2807602&req=5

Fig4: Pio Pico has striking clinical features of acromegaly in 1858 about 4 years after the death of his wife, Maria Ignacia. The left ocular globe is mildly proptotic and located eccentrically in the orbit compatible with tumor extension into the left cavernous sinus and orbit. Note the marked asymmetry of the location of the light reflection in each eye. We are unable to assess pupillary size. His hairless face could reflect secondary hypogonadism. The enlarged inset emphasizes his dysconjugate gaze and the loss of lateral eyebrows (compare with Fig. 1) suggesting hypothyroidism. At this point in his life he was a successful rancher, businessman, and landowner. Courtesy of the Bancroft Library, University of California at Berkeley
Mentions: Unregulated GH release most commonly arises from an anterior pituitary GH-secreting adenoma. Pio Pico exhibits three manifestations of his tumor. First, he persuasively demonstrates the systemic effects of GH excess (Fig. 1). Second, he has dysconjugate gaze (Fig. 1, inset). With a presumed pituitary adenoma this sign implies lateral growth from the sella turcica into the adjacent cavernous sinus. In 1858 he appears more acromegalic, but now with striking left eye displacement and slight proptosis (Fig. 4). Third, he has apparent secondary thyrotropin deficiency manifesting as the loss of lateral eyebrows [4] and, at least by history (see below), possible secondary hypogonadism, each of which can result from mass effect of his presumed GH-secreting tumor on the adjacent normal pituitary (Fig. 4). Up to 30% of GH-secreting pituitary tumors also produce excess prolactin [5] which can independently inhibit gonadotropin function.Fig. 4

Bottom Line: Pearce Bailey published the first account of pituitary tumor infarction only in 1898.Pico's undiagnosed, misunderstood, profoundly acromegalic appearance was widely misinterpreted, leading to pervasive, degrading, and highly prejudicial comments.This landmark case study in neuroendocrinology provides the opportunity to re-examine elements of 19th century California and American history.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, University of Virginia School of Medicine, Box 800394, Charlottesville, VA, 22908, USA. isl@hscmail.mcc.virginia.edu

ABSTRACT
We hypothesize that Pio Pico, the last Mexican Governor of California, had acromegaly between at least ages 43 to 57, from 1844 to 1858, before Pierre Marie published the clinical description of acromegaly in 1886. Pico's probable growth hormone-secreting pituitary tumor likely infarcted spontaneously after 1858. The tumor infarction resulted in burnt-out acromegaly and probably restored normal pituitary function. Pearce Bailey published the first account of pituitary tumor infarction only in 1898. Pico's undiagnosed, misunderstood, profoundly acromegalic appearance was widely misinterpreted, leading to pervasive, degrading, and highly prejudicial comments. This landmark case study in neuroendocrinology provides the opportunity to re-examine elements of 19th century California and American history.

Show MeSH
Related in: MedlinePlus