On the shoulders of giants: Harvey Cushing's experience with acromegaly and gigantism at the Johns Hopkins Hospital, 1896-1912

Courtney Pendleton, Hadie Adams, Roberto Salvatori, Gary Wand, Alfredo Quinones-Hinojosa

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)53-60
Number of pages8
JournalPituitary
Volume14
Issue number1
DOIs
StatePublished - Mar 2011
Externally publishedYes

Fingerprint

Gigantism
Acromegaly
Inpatients
Pituitary Gland
Headache
Length of Stay
Outpatients

Keywords

  • Acromegaly
  • Cushing
  • Gigantism

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism

Cite this

On the shoulders of giants : Harvey Cushing's experience with acromegaly and gigantism at the Johns Hopkins Hospital, 1896-1912. / Pendleton, Courtney; Adams, Hadie; Salvatori, Roberto; Wand, Gary; Quinones-Hinojosa, Alfredo.

In: Pituitary, Vol. 14, No. 1, 03.2011, p. 53-60.

Research output: Contribution to journalArticle

Pendleton, Courtney ; Adams, Hadie ; Salvatori, Roberto ; Wand, Gary ; Quinones-Hinojosa, Alfredo. / On the shoulders of giants : Harvey Cushing's experience with acromegaly and gigantism at the Johns Hopkins Hospital, 1896-1912. In: Pituitary. 2011 ; Vol. 14, No. 1. pp. 53-60.
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