A probable case of acromegaly from the Windmiller culture of prehistoric Central California

• An adult human skeleton from Central California shows craniofacial and postcranial osseous changes consistent with a diagnosis of acromegaly.
• Acromegaly is a rare disorder that has not been well-documented in prehistoric remains, especially from North America.
• This case study attempts to apply recent clinical criteria for diagnosing endocrine disorders in human skeletal remains.

A skeleton excavated from the Blossom Mound (CA-SJO-68), a Late Holocene (4350–2980 BP) site located in the northern San Joaquin Valley of California, exhibits evidence of unusual craniofacial and postcranial features consistent with endocrine disease. Burial 37, an adult male approximately 30–40 years of age, shows pronounced development of the mental eminence, glabellar region, and supraorbital arches, as well as elongation of the mandibular ramus, crowding and malocclusion of the anterior dentition, and periosteal bone formation at several enthesis sites. In addition, abnormal enlargement of the sella turcica as well as pneumatization of the frontal and maxillary sinus and mastoid air cells was observed.These skeletal characteristics are consistent with a diagnosis of acromegaly, an endocrine disorder characterized by the enlargement of bone and soft tissue resulting from a pituitary gland tumor that increases the secretion of growth hormone. Onset typically occurs after epiphyseal fusion, a characteristic that distinguishes it from gigantism. This case study utilizes current clinical criteria for diagnosing acromegaly in human skeletal remains and discusses other evidence of this rare condition in the archeological record.