This episode isn’t just an excuse for me to talk about some wrestling history–it is definitely that though. It’s also to talk about a unique medical condition in how it affected a special person in the world of wrestling. We’ll start by talking about Andre The Giant, one wrestler that many non-fans of the sport have probably heard of, and then we’ll pivot to talking about the medical condition that made him so famous.
I promise I won’t go too far into the wrestling side of this story so Mike doesn’t leave, but we have to talk about a bit of it because it’s awesome.
Andre Rene’ Roussimoff grew to be every bit the giant of his namesake, both in physical stature and his career in the world of professional wrestling, which some might argue is the pinnacle of performance art and human achievement. I would argue that it is.
After his initial training as a wrestler in France where, again he was an 18 year old, 7+ foot teenager who could just lift cars, mind you, he eventually made his way over to the U.S. where he wrestled in various regional wrestling territories as a true spectacle. He would come to town, beat everyone while crowds stood in awe of his size and ability to pick up and throw his opponents whether or not they wanted him to. Then he’d move on to the next town and the next wrestling territory. It was important not to keep him in town forever since nobody who saw him would ever believe he would lose a match. That’s also why he rarely if ever won championship belts.
In 1973, he captured the attention of Vince McMahon Sr. who brought him into what was known as the WWF at that time. Note this was the father of the Vince McMahon who presently oversees the WWE and is known to not only be a ruthless businessman, but also to be a person who should not have a mustache–gotta be aware of recent wrestling to appreciate that one, but I know someone out there will. It makes him look every bit as unsettling as his history in the wrestling business would suggest he is.
During his career, Andre was billed as being 7’4” and up to 555lbs. It may shock you to know that there may be some exaggeration in wrestling when it comes to these things, but it’s probably only a little bit over the mark for Andre’s true size. He was called the 8th Wonder of the World and indeed did wrestle all over the world. His biggest match, perhaps, was at Wrestlemania III in 1987, when I was all of 5 years old, Walk Like an Egyptian by the Bangles was #1 on the Billboard charts, and Aaron and Mike were celebrating their graduation from medical school, to give everyone historical context.
Andre allowed Hulk Hogan to bodyslam him and was pinned in front of 78,000 fans–arguably the pinnacle moment for 1980’s wrestling. I did say he “allowed” Hogan to do so because, given his size, if Andre didn’t want to lose, he wouldn’t. I encourage everyone to check out the excellent HBO documentary on Andre the Giant to hear anecdotes about the times Andre didn’t like the wrestlers he was pitted against and used his size to make their time in the ring together difficult.
And lastly, if you didn’t know him for the wrestling, you probably saw him in several movies.
He was the star of the 1987 hit, The Princess Bride, where he played Fezzik who was, also a giant. I don’t know who else was in that movie because it had Andre the Giant in it and that’s by far the coolest thing about the movie.
At this point, I hate to turn away from talking about wrestling, but there is a medical history part of all of this. Now that we know a bit about the man’s wrestling career, let’s talk about the underlying condition that made him 7+ feet tall, aptly named gigantism, and how it was discovered. I’ll note here that this condition may be referred to as acromegaly and I’ll be sure to tell you the difference between the two after we get to what causes them. For now I’ll use them interchangeably, but there is a difference.
The first time a physician described gigantism was in the 16th century. It wasn’t the first case ever, of course, just the first time a physician took the time to write a scientific–if not rude and unkind–account of a patient having it. There is little to no tact in historic medical writings.
Johannes Wier (pronunciation?) was a Dutch physician who in 1567 wrote about what he dubbed a “female giant.” She was 25 years old and had been making a living as a traveling sideshow performer to support her parents. Her stature was the show. She had apparently been normal in appearance until her early teens when her height, facial, and extremity size had all increased markedly. I mentioned his description was unkind and include it as an example of how harsh earlier medical journal observations could be, “her form was not attractive, her temperament was simple and stupid, and her whole body was sluggish.”
If I could say anything redeeming about Dr. Weir’s writing, it’s that he would go on to write a bunch of treatises on why burning women for witchcraft was dumb and cruel and he apparently may have been among the first to use the term “mentally-ill” to describe women accused of witchcraft as opposed to saying they were, you know, “a witch.” So I guess that’s kind of progressive for the 16th century, maybe?
Many cases of similar patients with similar findings–large extremities (especially hands, feet, heads/faces and tall stature) would be described over the subsequent centuries–interestingly enough often in France and the UK and Ireland it so happens.
The first time the term “acromegaly” was used to describe this was in 1886 by French neurologist, Pierre Marie. Pierre was covering for his buddy, a physician named Jean-Martin Charcot who was a big fan of things that come in threes. Pierre Marie was seeing a few of his Charcot’s patients in late 19th century Paris–not clear if they were referred to him or he was, like, taking call for the clinic or something.
One woman, aged 24, stopped in after her relatives noted a significant change in her appearance. Not sure why or what she was doing, but she was away from her family for a few years and when she’d returned many of them could not recognize her, due to the change in her appearance. Her face had grown, her arms, legs, and hands were quite large, and she, to Dr. Pierre Marie’s surprise, did not resemble old photos of herself. He dubbed the condition “acromegaly” which refers to extremities (akron - tip) and large (megas). Incidentally, she was having some difficulties with her vision which is a clue to what causes this condition. Let’s go there next.
Ever since Dr. Wier’s initial description, on through the centuries leading up to Dr. Marie’s coining of the term, many physicians were aware of patients with enormous extremities and general size, and some of them were finding a curious association when they decided to open them up–post mortem, of course.
We’ll start with a missed opportunity to make an eponym. A historically famous Scottish surgeon of the 18th century, John Hunter, came close to being the first to find a clue. He’s like the Drew MacIntyre of the world of surgical history, just for reference.
He had procured the body of a man named Charles Byrne (aka Patrick O’Brien–I did not dive into why he had such different names) who was 7’7” and therefore known as “The Irish Giant”. Hunter loved collecting specimens like other people collect baseball cards or pokemon. He was able to keep Byrne’s enormous skeleton for his collection but he never opened it up. My wife would not have that problem since, whenever she gets a new wrestling action figure as a present, opens the package and immediately nosedives its value.
Fast forward to an Italian neuropsychologist named Andrea Verga who did open up his patient up during his career in the 19th century. He was working at an Italian hospital in the 1860’s when he noted a woman (I think she was a patient) who had what he called “prosopo-ectasia” or big face.
He was also not kind in describing her features as you might imagine.
She died a few years later in 1862 of infectious illness and he did an autopsy–I don’t know that she was a longer term patient of his or if you could call a weird sort of dibs on patients bodies or however he was able to do this–but he found a “walnut sized” tumor in the region of her pituitary gland. Notably, he did not find a normal pituitary gland.
That patient was also having vision difficulties when she was alive because, anatomically, the pituitary gland sits near near a big ol’ crossing of vision nerves called the optic chiasm, which carry signals from your eyes to the brain. Tumors of the pituitary can grow to push on the chiasm and cause vision changes.
Many, many autopsies on patients with acromegaly or gigantism were performed, all of which seemed to have abnormal growths on the pituitary gland. In fact, one Lithuanian endocrinologist-diabetologist (redundant specialty name) named Oskar Minkowski noted in 1887–the year after Acromegaly was named–that all patients with the condition had these pituitary tumors on autopsy.
That same year, an Italian physician named Vicenzo Brigidi did an autopsy of the brain of the Italian actor Ghirlenzoni (single name, like Cher?). He had acromegaly. Birgidi put was the first to look at the tissue under a microscope. Subsequent physicians found further evidence, microscopically, that the cells of the pituitary seemed to be really, really active. At this point the physicians of the late 19th century were pretty sure the pituitary tumors were causing acromegaly/gigantism. They were right.
Here’s what’s happening with this condition. In 95% of cases, a non-cancerous tumor grows in the part of the pituitary gland that makes something called “growth hormone.” It’s nice when medicine names things for what they do. Growth hormone causes many tissues of the body, especially muscles and bones to grow, including those of the face and extremities. When you hear about athletes taking HGH (especially if they’re going up in hat sizes as the skull thickens), they’re injecting a synthetic form of this hormone to grow muscles. There are many other effects of GH but that’s beyond the scope of this show.
So this is where the difference between gigantism and acromegaly comes into play. They are both due to excess production of growth hormone from the pituitary tumor. The difference is WHEN that production starts.
If it starts before puberty–i.e. before most of the bones are done growing in length, then you have gigantism, which not only includes enormous growth of arms, legs, feet, and face, but significant height increase since the bones can grow longer as well. In acromegaly, the growth hormone excess starts AFTER puberty, when bones no longer grow in length, but can, with extra growth hormone, grow thick and distorted.
Both conditions can affect the shape of the face in slightly different ways because of this. Also important to know that soft tissues like the tongue or soft tissues (the meat, if you will) of the extremities will grow as well.
Acromegaly and Gigantism are fortunately treatable, to a degree. If recognized early, the first line is surgical removal of the tumor which stops the extra growth hormone from causing the changes.
The earlier you catch it, the less the changes become permanent. Surgical treatment was an early recommendation after they figured out the pituitary tumor was the problem.
In 1908, Austrian surgeon Julius Von Hochenegg performed the first trans-sphenoidal approach for treatment of acromegaly, earning a headline in the NY Times that year of “ACROMEGALY CURED.” Well, it wasn’t far off but it wasn’t until surgical microscopes became all the rage in mid 20th century that this surgery was refined and more often successful.
There are now some medications that can be used if surgery is not an option or to temper the condition if surgery is not completely successful.
Let’s finish out this story with the end of Andre’s life.
Andre likely knew as early as the 1970’s that he’d had gigantism. According to one of his close friends, he had said that, on his initial wrestling trip to Japan–where he was an incredible wrestling star–he was told by a physician there that he likely had a pituitary tumor. It was not confirmed and there is speculation as to why he did not seek out surgery at that time. It might have been that there was a language barrier between Andre’s lack of French interpreter while in Japan, or that he may have known the option was there and decided against it.
His friend said Andre was told he could have surgery while in Japan but that he said “God made him that way and he wasn’t going to change that.”
In 1981, orthopedist, Dr. Harris Yett, diagnosed Andre with a broken ankle and being a giant human being. Prior to having the Giant undergo surgery and what I can only assume is an enormous dose of anesthesia, Yett had confirmatory testing done to, well, confirm, that Andre did have gigantism. Surgery on his pituitary was discussed but Andre declined because “he thought it would interfere with his career as a wrestler.”
The sad thing, among many, is that if Andre had the surgery in 1981, he would have likely lived a longer life. His skeletal structure would not have changed, per se, but it’s likely the excess soft tissues may have shrunk and that he could have continued his wrestling career longer than he was able to. Andre really, really loved wrestling and what it gave to him and it seemed as if he accepted the fact that he would die young, but would live the life of a star in the meantime.
If that trade off seems difficult to accept, consider how hard life was for Andre–and indeed others who have conditions of acromegaly and gigantism. He was comfortable being a Wonder of the World in the wrestling ring, but outside of it, he just wanted a normal life. He couldn’t use a bathroom on flights overseas. Clothing and furniture had to be custom made. People always tried to exploit him for his size and he knew that. So maybe that’s why he decided to forgo a treatment that would still, essentially leave him the way he was?
By the late 1980’s, Andre’s career and health were on a precipitous decline. He had mounting back issues and could barely walk. His weight continued to grow as did the size of his heart.
Andre died at age 46 of a suspected heart attack complicating congestive heart failure, on Jan 28th, 1993.
He was alone in a Paris hotel room where he was traveling to attend his father’s funeral as sad as that is.
You might imagine that Andre the Giant was not the only wrestler to have gigantism. Many before him did. One notable example is still wrestling today, albeit on a limited basis. Formerly known as “The Big Show” in WWE and “The Giant” in WCW before that, Paul Wight was diagnosed with his pituitary tumor in his late teens.
He had it surgically removed and remained 7ft tall and between 383-500lbs at various points in his wrestling career. He’s 51 years old and active in wrestling to this day. I hope he’s a fan of this show! Hi Mr. Wight!
https://books.google.com/books?id=tYPCDwAAQBAJ&pg=PT78#v=onepage&q&f=false (suggestion that Andre may have been told of diagnosis in Japan in 1970’s)
Doctor with a mustache.