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Gigantism or giantism, (from Greek gigas, gigantos "giant") is a condition characterized by excessive height growth. As a medical term, gigantism is rarely used except to refer to the rare condition of pituitary gigantism due to prepubertal growth hormone excess. There is no precise definition of the degree of tallness that qualifies a person to be termed a "giant." The term has been typically applied to those whose height is not just in the upper 1% of the population but several standard deviations above mean for persons of the same sex, age, and ethnic ancestry. more...

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Typical adult heights of Americans and Europeans to whom the term might be applied are 210 - 240 cm (7 - 8 feet) though it may be possible for a person to grow up to 270 cm (9 feet) or taller. The term is rarely applied to basketball players and those whose heights appear to be the healthy result of normal genetics and nutrition.

Pituitary gigantism

Pituitary gigantism due to growth hormone excess is the single condition that accounts for nearly all cases of pathologic extreme height. The excess growth hormone usually results from oversecretion by a group of somatotrope cells of the anterior pituitary gland (termed a "somatotrope adenoma"). These cells do not respond to normal controls of growth or function. They grow very slowly, so that for many years the only effects of such an adenoma are the effects of excessive growth hormone.

The primary effect of growth hormone excess in childhood is excessive growth, but the tallness is accompanied by a characteristic physique recognizable to an endocrinologist. The typical physique involves heavy, thick bones, with large hands and feet and a heavy jaw. Once puberty is complete and adult height is achieved, continued thickening of the skin and growth of the jaw results in a combination of features referred to as acromegaly. Over decades, such an adenoma may reach a large enough size (2 cm or more in diameter) to cause headaches, impair vision, or damage other pituitary functions. Many years of growth-hormone excess can cause other problems as well.

If pituitary gigantism or acromegaly is suspected by a physician, the simplest diagnostic screening test is measurement of insulin-growth factor 1 in the blood. This is usually quite elevated but levels must be interpreted in relation to age and pubertal status. Additional confirmatory testing may include magnetic resonance imaging (MRI) of the pituitary to look for a visible adenoma, and suppressibility of growth hormone levels by glucose. Treatment depends on the size of the adenoma and may involve removal by a neurosurgeon, drugs such as octreotide or bromocriptine, or radiation. Treatment is discussed in more detail in the acromegaly article.

Childhood pituitary gigantism is a rare condition, and those affected are often unusual enough to attain a degree of celebrity status (e.g., André the Giant) Acromegaly is the term used for the condition of growth hormone excess when it occurs in adults. Acromegaly is a far more common disease in adults than pituitary gigantism is in children.

Other conditions of overgrowth or excessive tallness in childhood

Children who are excessively tall are often referred to pediatric endocrinologists for evaluation. The majority of children who seem excessively tall or large to their parents usually have a combination of simple familial tallness and childhood obesity.


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Building for people
From National Review, 8/23/04 by M.D. Aeschliman

Timeless Cities: An Architect's Reflections on Renaissance Italy, by David Mayernik (Westview, 288 pp., $26)

TRADITION, T. S. Eliot wrote 85 years ago, cannot "be inherited, and if you want it you must obtain it by great labor." As Tom Wolfe showed in his hilarious 1981 satire on modern architecture, From Bauhaus to Our House, all the most influential early- and mid-20th-century Modernist "master" architects found the weight and trajectory of traditional architecture humiliatingly oppressive and irrelevant to modern conditions. With the German emigre Walter Gropius they wanted to "start from zero"; with the Italian "Futurist" Filippo Tommaso Marinetti they wanted to celebrate "the joy of mechanical force." The assertion of their contemporary, Eliot, about tradition was thus--to them--retrospective, nostalgic, lugubrious.

Our Modernist urban wastelands and strip developments are their legacy, now everywhere in the world, from Las Vegas to Lugano to Chandigarh. Of course human vanity and greed, shortterm self-love and self-interest, have been efficient causes in the generation of the loveless, tasteless public and private buildings and spaces that litter the world today; but their ultimate or deeper causes come from the dominant "progressive" zeitgeist of modernism that replaced McKim, Mead, and White buildings with those by Gropius, Le Corbusier, Louis Kahn, Frank Gehry, and their thousands of admirers and imitators. As David Watkin pointed out in his classic Morality and Architecture, the Modernists' "blind worship of the new" and "hatred of the past" have vandalized Western cultural ecology. Building plans such as Frank Gehry's new Stata Center at MIT are almost unbelievably ugly and perverse, proving that our century is a great age of credulity.

Yet an important renegade reaction or salvage operation has been performed by thousands of preservationists--mostly earnest, civic-minded nonprofessionals--all over the world, from small American cities such as Portsmouth, N.H., to famous British and Italian cities. In England, Sir John Betjeman's efforts to save Victorian buildings were augmented by a brilliant 1977 BBC-TV series called City of Towers. This film impressed Prince Charles of England and led to his own documentary and book, A Vision of Britain (1989), deploring "the wanton destruction which has taken place in this country in the name of progress."

But Prince Charles did more than protest. He sought out and gave some patronage to a brilliant renegade architect and architectural theorist named Leon Krier, who has served as the central inspiration of a group of neo-classical architects and urbanists of great talent and determination who have had the courage and wit to attack the wreckers--and to provide alternatives. In 2003 the first Richard Driehaus Prize for Classical Architecture--$100,000--was awarded to Krier in a ceremony at the Art Institute of Chicago: a direct challenge to the enormous power and prestige of the Modernist establishment.

Krier's visionary urbanism has reshaped whole urban quarters, including Poundbury in England and Citta Nuova (Alessandria) in Italy; he has also been a major inspiration for Robert Davis's marvelous town, Seaside, in the Florida panhandle. Among Krier's other impressive allies and students are David Watkin, Demetri Porphyrios (now at work on major buildings at Princeton), Andres Duany and Elizabeth Plater-Zyberk of the University of Miami, and the Englishmen John Simpson and Quinlan Terry. One of the most brilliant of his younger followers is the American David Mayernik, who has recently erected a magnificent gymnasium and a beautiful library, with adjacent piazzas, at The American School in Switzerland, near Lugano.

Mayernik's new book may be called an exercise in the kind of "visionary traditionalism" characteristic of Krier and several centuries of architects before him, especially those of the Italian Renaissance. Timeless Cities is a consideration of four great and famous Italian cities--Rome, Venice, Florence, and Siena--and one small and relatively unknown one, Pienza, in terms not mainly historical or touristic but as models of a "usable past," as resources for the better construction of future cities. This is a hard task: Most of us who love these cities find them inexhaustibly interesting to walk in, observe, and read about, but we suffer from the underlying suspicion that the neo-barbarian modern cities we now inhabit and their socio-economic dynamics have rendered impossible a revival of humane urbanism. We have been expelled from the commodious cities of man and God by irreversible mechanized brutality and progressive visual desensitization. The high Modernists despised human scale in favor of humiliating gigantism and "machines for living"; in those machines we now live.

"We have the paradox today," Mayernik argues, "of being a generally more equitable society than, say, 14th-century Siena, but we have built for ourselves a far less humane environment." Cities such as Siena, Mayernik writes, "are still accessible to us, and they often strike visitors as oddly familiar, more like home than home itself." Mayernik's analysis and argument involve a subtle but deft critique of our currently dominant intellectual elites: "It has been a mistake for urban theorists in the past two centuries to have effectively substituted the mechanics of politics for the values of religion as the only elevated content cities can embody."

The totalist, leftist political visions of the Modernist architect-emigres to the United States were effectively mocked by Tom Wolfe, and never had much political currency here to begin with. But like the mockery by sophisticated, "value-free" European emigre academics of "naive" American pieties such as "natural rights" (which the grateful emigre Leo Strauss defended), the Modernists' mockery of beaux-arts classicism was very effective in America, leaving us with "the naked public square" in several senses. No leftist (or fascist) project filled the square in this country, but Modernist commercial neo-brutalism did. As Burke pointed out, for us to love our country it needs to have something lovely about it. There are several things of infinite value worth loving America for, but our Modernist-built landscape is not among them. It is little wonder that many thoughtful people now treasure the early-20th-century legacy of McKim, Mead, and White.

Like his mentor Leon Krier, David Mayernik has obtained the tradition "by great labor." Not only a gifted architect, draftsman (his book is illustrated with his own drawings, including a beautiful cover), and fresco painter, he is also a skillful literary advocate for a "visionary traditionalism" as the urban agenda for a 21st-century renaissance.

Mr. Aeschliman is a professor at Boston University and the University of Italian Switzerland and also the founder-director of the Erasmus-Jefferson Summer Institute in Tuscany (in collaboration with the University of Virginia), now in its ninth summer.

COPYRIGHT 2004 National Review, Inc.
COPYRIGHT 2005 Gale Group

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