The possibilities and impossibilities of treating acromegaly 50 years ago illustrated by the Diane Arbus photograph, A Jewish giant at home with his parents in the Bronx, N.Y. 1970.

SUMMARY

The iconic photograph 'A Jewish giant at home with his parents in the Bronx, N.Y. 1970' by the famous American photographer Diane Arbus (1923-1971) shows the 2.34 m (7 ft. 8¼ in.) acromegalic giant Eddie Carmel (1936-1972) and his parents in the living room of their New York home. The picture is a typical example of Arbus' style. The relationship between the artist and the tall subject is described. A growth hormone-secreting pituitary macroadenoma was unsuccessfully treated with two cycles of pituitary radiotherapy achieving a 7000 rad cumulative dose and by incomplete pituitary surgery. Hypopituitarism was treated according to medical standards in the 1960s and 1970s. The giant patient died of increased intracranial pressure and at autopsy a residual acidophil pituitary macroadenoma was found, but also a perisellar meningioma which was most probably induced by the high dose of pituitary radiotherapy. The case report illustrates the possibilities and impossibilities of treating acromegaly 50 years ago and demonstrates the potential risks of high dose pituitary radiotherapy (in acromegaly).

LEARNING POINTS

Acromegaly is a very old disease. Therapy for acromegaly has evolved over the decades. In art museums one can come across artistic impressions of endocrine disorders. People suffering from disfiguring endocrine disorders like acromegaly were pre-WW2 'exposed' in theaters and circuses. High dose pituitary radiotherapy can be associated with secondary brain tumor formation.