TY - JOUR
T1 - On the shoulders of giants
T2 - Harvey Cushing's experience with acromegaly and gigantism at the Johns Hopkins Hospital, 1896-1912
AU - Pendleton, Courtney
AU - Adams, Hadie
AU - Salvatori, Roberto
AU - Wand, Gary
AU - Quiñones-Hinojosa, Alfredo
N1 - Funding Information:
Acknowledgments CP supported by a HHMI-Ivy Research Training Grant. HA supported by VSBfonds and The Prins Bernhard Cultuurfonds. AQH funded by the KO8 NIH grant and an HHMI grant. Figures provided courtesy of the Alan Mason Chesney Archives. Parts of this research were presented at the 2010 Endocrine Society Conference in San Diego, CA.
PY - 2011/3
Y1 - 2011/3
N2 - A review of Dr. Cushing's surgical cases at Johns Hopkins Hospital revealed new information about his early operative experience with acromegaly. Although in 1912 Cushing published selective case studies regarding this work, a review of all his operations for acromegaly during his early years has never been reported. We uncovered 37 patients who Cushing treated with surgical intervention directed at the pituitary gland. Of these, nine patients who presented with symptoms of acromegaly, and one with symptoms of gigantism were selected for further review. Two patients underwent transfrontal 'omega incision' approaches, and the remaining eight underwent transsphenoidal approaches. Of the 10 patients, 6 were male. The mean age was 38.0 years. The mean hospital stay was 39.4 days. There was one inpatient death during primary interventions (10%) and three patients were deceased at the time of last follow-up (33%). The mean time to death, calculated from the date of the primary surgical intervention, and including inpatient and outpatient deaths, was 11.3 months. The mean time to last follow-up, calculated from the day of discharge, was 59.3 months. At the time of last follow-up, two patients reported resolution of headache; four patients reported continued visual deficits, and two patients reported ongoing changes in mental status. This review analyzes the outcomes for 10 patients who underwent surgical intervention for acromegaly or gigantism, and offers an explanation for Cushing's transition from the transfrontal "omega incision" to the transsphenoidal approach while practicing at the Johns Hopkins Hospital.
AB - A review of Dr. Cushing's surgical cases at Johns Hopkins Hospital revealed new information about his early operative experience with acromegaly. Although in 1912 Cushing published selective case studies regarding this work, a review of all his operations for acromegaly during his early years has never been reported. We uncovered 37 patients who Cushing treated with surgical intervention directed at the pituitary gland. Of these, nine patients who presented with symptoms of acromegaly, and one with symptoms of gigantism were selected for further review. Two patients underwent transfrontal 'omega incision' approaches, and the remaining eight underwent transsphenoidal approaches. Of the 10 patients, 6 were male. The mean age was 38.0 years. The mean hospital stay was 39.4 days. There was one inpatient death during primary interventions (10%) and three patients were deceased at the time of last follow-up (33%). The mean time to death, calculated from the date of the primary surgical intervention, and including inpatient and outpatient deaths, was 11.3 months. The mean time to last follow-up, calculated from the day of discharge, was 59.3 months. At the time of last follow-up, two patients reported resolution of headache; four patients reported continued visual deficits, and two patients reported ongoing changes in mental status. This review analyzes the outcomes for 10 patients who underwent surgical intervention for acromegaly or gigantism, and offers an explanation for Cushing's transition from the transfrontal "omega incision" to the transsphenoidal approach while practicing at the Johns Hopkins Hospital.
KW - Acromegaly
KW - Cushing
KW - Gigantism
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U2 - 10.1007/s11102-010-0258-z
DO - 10.1007/s11102-010-0258-z
M3 - Article
C2 - 20821269
AN - SCOPUS:79951960242
SN - 1386-341X
VL - 14
SP - 53
EP - 60
JO - Pituitary
JF - Pituitary
IS - 1
ER -