title: On the shoulders of giants: Harvey Cushing's experience with acromegaly and gigantism at the Johns Hopkins Hospital, 1896-1912.
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.
authors.affiliation: Brain Tumor Stem Cell Laboratory, Department of Neurosurgery and Oncology, Johns Hopkins School of Medicine, Baltimore, MD 21231, USA.
authors.forename: Courtney
authors.initials: C
authors.lastname: Pendleton
authors.forename: Hadie
authors.initials: H
authors.lastname: Adams
authors.forename: Roberto
authors.initials: R
authors.lastname: Salvatori
authors.forename: Gary
authors.initials: G
authors.lastname: Wand
authors.forename: Alfredo
authors.initials: A
authors.lastname: Quiñones-Hinojosa
mesh_terms: D000172:Acromegaly / Q000601:surgery*; D000328:Adult; D003480:Cushing Syndrome / Q000601:surgery*; D005260:Female; D005877:Gigantism / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010902:Pituitary Gland / Q000601:surgery*; D012189:Retrospective Studies; D055815:Young Adult
references.citation: J Neurosurg. 2005 Dec;103(6):1096-104
references.pmid: 16381201
references.citation: J Physiol. 1902 Sep 12;28(5):325-53
references.pmid: 16992627
references.citation: Ann Surg. 1909 Dec;50(6):1002-17
references.pmid: 17862444
references.citation: J Neurosurg. 1981 Apr;54(4):448-54
references.pmid: 7009800
references.citation: Nat Rev Endocrinol. 2010 Jan;6(1):48-52
references.pmid: 20010970
references.citation: Pituitary. 2010 Dec;13(4):324-8
references.pmid: 20607416
references.citation: Neurosurg Rev. 2010 Jan;33(1):63-70
references.pmid: 19727873
references.citation: Ann Surg. 1913 Feb;57(2):145-50
references.pmid: 17862963
references.citation: Br Med J. 1893 Dec 30;2(1722):1421-3
references.pmid: 20754579