MedTerm Corner: Acromegaly continued

anatomy of pituitary gland and optic nerve

MedTerm Corner: Acromegaly continued

Last time I promised to tell you what some scientists in the medical community, as well as some ideas from Malcolm Gladwell, think about the battle between David and Goliath and how acromegaly fits in that.

Malcom Gladwell TED Talk David and Goliath

Just another reminder about Acromegaly:
Acromegaly (from Greek ἄκρος — limb and Greek μέγας — big/ large) — is a disease related to the dysfunction of the front lobe of the Pituitary gland or Hypophysis. The name of the front lobe of the pituitary gland is Adenohypophysis (aden/o – root word for “gland”). Acromegalic patients will have an enlargement (widening and thickening) of wrists, feet, cranial (skull) bones especially facial part of the cranium (crani/o is a root word for “skull”).

Many human giants in today’s world have a rare disease called Acromegaly which is caused by over production of human growth hormone. The most common cause (95%) of this problem is a benign, hormone producing tumor of the pituitary gland. If the tumor occurs early in life when cartilage growth plates in bones are not closed yet and still active, the result is massive growth in stature until the growth plates close. If the over production of the growth hormone continues after the growth plates close, some bones, including the jaw and other bones in the face, feet, wrists, etc. will continue to thicken. Slowly other typical characteristics of adult onset acromegaly develop: enlargement of the supraorbital ridge (thickening of the forehead), cheekbones, chin, nose, lips and ears. Skin folds develop on the face. The voice is gruff due to the voice cords thickening. Chest wall enlarges, spine deforms. The bones are thickening and increasing in width. Early onset arthritis develops. In extreme cases acromegalic giants can grow to over eight feet if untreated.

Anatomically, (see picture below) the pituitary gland lies close to where the two optic (opt/o – root word for “eye”) nerves meet and cross (optic chiasm) – at the base of the brain, which means a pituitary tumour can press on the optic nerves and damage the part of the optic pathway responsible for the peripheral or side vision. This results in loss of vision from the sides of the visual fields, so acromegalic giants can have a defect sometimes called “tunnel vision” – they are severely short sighted and can see only what is right in front of them. Anyone suffering from this would certainly have trouble dodging any stones thrown at them.

anatomy of pituitary gland and optic nerve


Goliath was a giant Philistine warrior, he was a huge and scary man with horrendous voice who was terrifying to all people around him but was defeated by the young shepherd named David, who killed him with a sling and a stone.

Suppose, Goliath was an acromegalic giant, and therefore probably short sighted, he simply wouldn’t have seen David’s stone coming.

Goliath also seems to have been a great warrior from his youth, who fought with heavy armour and weapons. People with acromegalic gigantism may be large in size, but they are not really fit. Their large growth caused by excess hormones is not a healthy growth. The excessively long limb bones of acromegliacs mean that just walking and running subject their bones and joints to large twisting and sideways forces, and the strain on the joints from these and their large body weight leads to the arthritis early in adult life. Excess human growth hormone also makes their internal organs grow and malfunction. If left untreated people with acromegaly die prematurely. So a life in the military as a front line warrior is definitely out! Or may be not…

It is a very interesting application of the symptoms of the disease to the famous story, though.

Rita Galin
Supervisor, Russian Interpreter at UMHS Interpreter Services
Rita was born in Estonia, but her native language is Russian. She has a medical degree from Tartu State University (Tartu, Estonia), one of the oldest universities in Europe. She completed an internship in Neurology and Neurosurgery, attended and completed Adolescent Pathophysiology courses in Continuing Medical Education Institute, and worked as a Neurologist at the Adolescent Outpatient Clinic in Tallinn, Estonia. Rita’s clinical interests are in Adolescent Neurologic Pathophysiology as well as Young Adult Psychology.

Rita has worked for the University of Michigan Health System since 1995 as a Medical Interpreter, and was one of the first two staff Medical Interpreters at UMHS. She has presented on Cultural Specifics and Differences between medical systems in the former Soviet Union and the US. She has assisted in the creation of a video training on clear communications with LEP patients through an Interpreter for medical students at UMHS.

Rita is one of the creators of and the only instructor of the UMHS Interpreter Services course Medical Terminology and Body Systems, a 40-hour training that is national accredited by CCHI. She is also a member of the Diversity at the End of Life Committee at UMHS.

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