User:Samson22911/Sandbox

Medical history
Images of Pio Pico from 1847 through 1858 show a characteristic pattern of progressive acromegaly, a disease caused by excessive and unregulated release of growth hormone from a growth hormone-secreting adenoma of the anterior pituitary gland. [3]  He demonstrates progressive coarsening of his facial features with a large bulbous nose, broad forehead, protuberant lips and forward-jutting jaw (prognathism). His hands reveal the diagnostic massive enlargement so typical of this illness. With a height of just 67 inches in his forties, his acromegaly must have started after puberty because otherwise he would have manifest gigantism. Images of some siblings, younger brother Andres Pico and elder brother, Jose Antonio Pico II show normal body features suggesting Pico's condition was a true disease and not simply a benign familial trait. Pio Pico has never been recognized or diagnosed previously with acromegaly.

The apparent pituitary adenoma had at least three additional secondary effects on his medical condition besides causing acromegaly. First, his eyes show progressive misalignment indicating the tumor grew laterally into the cavernous sinus compromising the function of the cranial nerves controlling eye muscle power. Second, he has a hairless face. Although potentially just a personal choice, in the presence of a large pituitary tumor, this is more likely due to testosterone deficiency. This condition results from the enlarging tumor interfering with the normal function of gonadotropin pituitary cells resulting in secondary hypogonadotropic hypogonadism and infertility. Third, in 1858 his lateral eyebrows were absent indicating secondary hypothyroidism, also caused by the tumor compromising function of the normal pituitary thyrotrope cells. The 1852 daguerreotype image of Pio Pico [3] may be the earliest objective image of acromegaly ever recorded because the disease was not recognized and named until Pierre Marie coined the term in 1886 while working in the clinic of Charcot in Paris, France.

Acromegaly is usually a fatal illness if untreated; 80% of patients die within 10 years of the diagnosis. Yet, Pio Pico died 46 years after the 1858 image when his disease was floridly active and already present for at least 11 years. This highly unexpected situation is likely due to spontaneous pituitary apoplexy, in this case, selectively involving his tumor but not the remainder of his own pituitary gland. [4]  In selective pituitary tumor apoplexy the adenoma undergoes infarction and shrinkage and disappears. No longer compressed by the adenoma, the nerves to his eyes can resume normal function and his remaining pituitary cells can restore normal levels of gonadotropic and thyrotropic hormones. Most importantly, absent the abnormally elevated levels of growth hormone that were released by the tumor, the features of acromegaly quickly regress. Careful inspection of his appearance in his 90’s (as shown in the full body image at the top of the article) reveals a dramatic reversal of all the abnormal features that were so prominent earlier in his life. [3] His hands are delicate and slender, his eyes are now precisely aligned, his eyebrows have returned and he has a full beard. Although the beard partly obscures his facial features, his lips, nose and forehead are no longer large and coarse. He looks perfectly normal in these later years. Pico was remarkably fortunate however, because the mortality from pituitary tumor apoplexy in his pre-treatment era was 50%, and over 80% of patients who survived had inadequate function of the remaining pituitary hormone cells. It is difficult to determine how soon after 1858 the apoplexy developed to cause his striking recovery because there are no photographs to be found of Pico between 1858 at age 57 and the images of him in his 90's. In 2009 the Workman and Temple Family Homestead Museum, the burial site of Pio Pico and his wife, received a previously unseen 1873 photograph of Pio Pico donated by a descendant of the Temple family. Compared with the 1858 image (above and to the left) Pico at age 72 now shows a generous beard, full eyebrows, symmetrical light reflection on his eyes and less prominence of his acromegalic features. His appearance at age 72 is virtually identical to that in his 90s and supports the hypothesis that his selective pituitary tumor apoplexy actually took place between 1858 and 1873. This new image enhances the controversial probability that Pico was likely the biological father of Alfredo Romero born in 1871. Pico’s selective pituitary tumor apoplexy may be the earliest recorded clinical example of this event as documented photographically, because the first description of pituitary tumor apoplexy was published only in 1898. [4]

Pico suffered the dual misfortune of both disfigurement from acromegaly plus ridicule over his unavoidable appearance. Among others who maligned his appearance, Gertrude FH Atherton, a prominent San Francisco writer, was the most flagrant and described Pico in 1902 in this manner: “…an uglier man than Pio Pico rarely had entered this world. The upper lip of his enormous mouth dipped at the middle; the broad thick under lip hung down with its own weight. The nose was big and coarse, although there was a certain spirited suggestion in the cavernous nostrils…” [5]

Reference 3.	 Open Access; http://www.springerlink.com/content/u7645787h2435373/fulltext.pdf

4.

5.	Atherton GFA. The Pearls of Loreto. In: The Splendid Idle Forties. Kentfield, California: Allen Press, 1960, 26

6.       http://www.springerlink.com/content/5133k6g2v0263wg2/

Epilogue
Besides his major political and business contributions, his legacy now must include the landmark presentations of acromegaly and spontaneous selective pituitary tumor apoplexy with full recovery. There are no current references to any of a variety of symptoms he might have manifest from the tumor itself or the secondary symptoms it might have produced. A partial list of these symptoms could include headache, double vision, loss of vision, fatigue, chest pain, shortness of breath, frequent urination and extreme thirst, severe snoring, muscle weakness and impotence. Such information, when and if available, will potentially confirm and extend the current state of knowledge of his medical history.