Portrait of the Countess Anastasia Spini (1842): acromegaly in art.

To the Editor, Acromegaly is a systemic disease produced by excessive secretion of growth hormone and consecutively increased levels of insulin-like growth factor 1 (IGF-1) [1]. Clear features of acromegaly are evident in the portrait of the Countess Anastasia Spini by Giovanni Carnovali, also known as “Il Piccio”. Carnovali was born in 1804 in Varese, Northern Italy. Initially trained in neoclassicism, he soon moved to realism. Among his patrons were the Countess Spini, for whom he painted many portraits and landscapes. In this lesser-known painting, Countess Anastasia is portrayed late in life: she was born in 1770 and would have died in 1855, never having married. The painting of the Countess (dated to about 1842) clearly depicts facial features suggestive of acromegaly, such as prominent nose, enlarged jaws and brows, upper eyelid ptosis, and furrowed forehead due to coarse and thickened skin, with evident outgrowths of tegumental tissue (skin tags) [2] (Fig. 1). Moreover, the Countess’s fingers are short and stubby and her shoes appear to be several sizes too small, enlarged hands and feet also being symptomatic of acromegaly [3]. The golden snuff box that the Countess is holding is indicative of her habit of smoking. Little is known about the life of the Countess, except that she was interdicted on account of insanity and prodigality. The Countess’s appearance, as portrayed in this painting, was for long associated with a depressive disorder; however, it is likely that the psychiatric disorder is, in fact, related to acromegaly syndrome [4]. It is not known whether the Countess herself linked her physical appearance to a morbid condition.