title: [Henry IV of Castilla (1454-1474). An exceptional urologic patient. An endocrinopathy causing the uro-andrological problems of the Monarch. Chronic renal lithiasis (II)].
abstract: OBJECTIVE
  To review all known data about the endocrinopathy and renal disease suffered by Henry IV of Castile according to contemporary chronicles and manuscripts, comparing the clinical diagnosis made by Gregorio Marañon 70 years ago in his work "Biological essay about Henry IV and his time" (Madrid 1930) with present concepts, because we consider, as other medical authors, that his endocrinopathy is not well determined. Regarding his chronic renal lithiasis, it could have played an important role as negative factor in the Monarch's quality of life, and have been related to his endocrinopathy, so that it should also be reviewed.
  
  
  METHODS
  We reviewed a total of 10 chronicles and 5 contemporary manuscripts treating the look and diseases of Henry IV to obtain the most important data about both diseases and be able to characterize the kind of endocrine disease suffered by the Monarch, and all aspects regarding his lithiasis, and compare them with our current knowledge.
  
  
  RESULTS
  From the review of those chronicles and manuscripts, it is my opinion that Henry IV suffered acromegaly secondary to a GH and prolactine producing hypophyseal tumor from childhood, which might justify the impotence he suffered from his youth and other symptoms clearly referred in the chronicles. Chronic renal lithiasis (flank pain, lumbar illness, and hematuria) finally led to acute obstructive uropathy, main cause of his death. This fact has not been emphasized by historians. The renal lithiasis benign part of a multiple endocrine neoplasia syndrome (MEN I) can not be ruled out.
authors.affiliation: Servicio de Urología, Hospital Ramón y Cajal, Madrid, España.
authors.forename: Emilio
authors.initials: E
authors.lastname: Maganto Pavón
mesh_terms: D000172:Acromegaly / Q000209:etiology / Q000266:history*; D004700:Endocrine System Diseases / Q000150:complications / Q000266:history*; D005197:Famous Persons; D049668:History, 15th Century; D006801:Humans; D007669:Kidney Calculi / Q000266:history*; D010911:Pituitary Neoplasms / Q000150:complications / Q000266:history*; D013030:Spain; D014572:Urology / Q000266:history*