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Governor Pio Pico, the Monster of California...no More: Lessons in Neuroendocrinology

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Case Reports

Governor Pio Pico, the Monster of California...no More: Lessons in Neuroendocrinology

Ivan S Login et al. Pituitary.

Abstract

We hypothesize that Pio Pico, the last Mexican Governor of California, had acromegaly between at least ages 43 to 57, from 1844 to 1858, before Pierre Marie published the clinical description of acromegaly in 1886. Pico's probable growth hormone-secreting pituitary tumor likely infarcted spontaneously after 1858. The tumor infarction resulted in burnt-out acromegaly and probably restored normal pituitary function. Pearce Bailey published the first account of pituitary tumor infarction only in 1898. Pico's undiagnosed, misunderstood, profoundly acromegalic appearance was widely misinterpreted, leading to pervasive, degrading, and highly prejudicial comments. This landmark case study in neuroendocrinology provides the opportunity to re-examine elements of 19th century California and American history.

Figures

Fig. 1
Fig. 1
A daguerreotype c. 1852 shows Pio Pico at age 51. He drapes his arm around his wife with two nieces flanking the couple. This is his earliest objective published image and demonstrates signs of apparent acromegaly. The enlarged inset emphasizes his dysconjugate gaze but with normal lateral eyebrows. Courtesy of the Los Angeles County Museum of Natural History Foundation
Fig. 2
Fig. 2
This undated image shows Pio's younger brother Andres Pico (1810–1876). Andres had fine facial features, slender fingers, and hands with a ring on the right, and closely manicured facial hair. This healthy appearance minimizes the probability that the Pico family had an acromegaloid look in general, potentially a more trivial explanation for the striking qualities in Pio Pico. Courtesy of the Los Angeles County Museum of Natural History Foundation
Fig. 3
Fig. 3
This is a 15 × 24 in. full-length oil-on-paper portrait of Pio Pico c. 1847 donated in 1912 by Mrs. George A. Johnson, Pico’s niece and the former Estefana Alvarado. Many of Mr. Pico’s acromegalic features are apparent at age 46. Considering artistic rendition, the light reflections are symmetrical on each eye. Courtesy of the California History Section, California State Library, Sacramento, California
Fig. 4
Fig. 4
Pio Pico has striking clinical features of acromegaly in 1858 about 4 years after the death of his wife, Maria Ignacia. The left ocular globe is mildly proptotic and located eccentrically in the orbit compatible with tumor extension into the left cavernous sinus and orbit. Note the marked asymmetry of the location of the light reflection in each eye. We are unable to assess pupillary size. His hairless face could reflect secondary hypogonadism. The enlarged inset emphasizes his dysconjugate gaze and the loss of lateral eyebrows (compare with Fig. 1) suggesting hypothyroidism. At this point in his life he was a successful rancher, businessman, and landowner. Courtesy of the Bancroft Library, University of California at Berkeley
Fig. 5
Fig. 5
(A) Pio Pico at about 89 years old c. 1890. This image is important because no obvious acromegalic features remain. His face and hands have a normal appearance (compare hands with Fig. 1). He now has lateral eyebrows and a full beard, supporting healthy pituitary physiology. Courtesy of the Anaheim Public Library. (B) This undated image reveals a rather distinguished, healthy appearing Pio Pico at an advanced age. The clear full-face comparison to Fig. 4 demonstrates resolution of acromegaly, return of conjugate ocular gaze without proptosis (note the symmetrical position of the light reflection in both eyes), healthy eyebrows, and generous facial hair. Courtesy of the San Diego Historical Society

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