1 De Herder W The history of acromegaly. 2 Garstang J , 3 Myers CS The bones of Hen Nekht, an Egyptian king of the Thrid Dynasty. Figure The skull attributed to Sa-Nakht, photographed by Garstang in 1903 Show full caption (A) Frontal view and (B) lateral view. Gigantism and acromegaly are endocrinological conditions of the greatest antiquity.While mythology and literature abounds with descriptions of giants, the oldest reported palaeopathological cases are remains of a person with acromegaly from 9500 to 11 500 years ago found in New Mexico, USA, and remains of a giant with signs of acromegaly from ancient Egypt (Giza; c 2425 BCE [5th Dynasty]). In 1901, a skeleton was found in the Mastaba K2 tomb near Beit Khallaf, Egypt, which is estimated to date from the 3rd Dynasty (c 2700 BCE).The remains are of a very tall man (about 187 cm; figure ) and are attributed to King Sa-Nakht, who was an ephemeral king of Egypt during the 3rd Dynasty. It is far from certain whether the remains are really those of King Sa-Nakht, but for the medical assessment of potential gigantism this case has a great value as it could be the oldest known case. The original reports of when the skeleton was found in 1901 gave no definitive diagnosis of either acromegaly or gigantism—both conditions having then already been described in the medical literature—although the case is described several times in general terms in the endocrinological literature.

4 Zakrzewski SR Variation in ancient Egyptian stature and body proportions. 5 Habicht ME

Henneberg M

Öhrström LM

Staub K

Rühli FJ Body height of mummified pharaohs supports historical suggestions of sibling marriages. In the present investigation, we assessed measurements of the skull from previously published articles and reviewed photographs of the skull. We compared these data with two anthropological databases (Howells [1973] and an unpublished database; appendix ). We tested several body height formulae on the published long bone data ( appendix ). All reconstructed heights were Z scored against the mean and SD for ancient Egyptian male commoners,and mean and SD of recumbent body length of male members of the ancient Egyptian royal family.Even though the kings were taller than commoners, the alleged Sa-Nakht is much taller than other royals (average Z score 3·5). Only his long bones show signs of exuberant growth (gigantism), while the dimensions of his face do not exceed more than 2 SD (with the exception of the bigonial breadth) compared with other royals ( appendix ). This finding could indicate an enlargement of the mandible, although other dimensions of the face are not excessively enlarged.

5 Habicht ME

Henneberg M

Öhrström LM

Staub K

Rühli FJ Body height of mummified pharaohs supports historical suggestions of sibling marriages. The alleged Sa-Nakht probably had gigantism, truly being the oldest known palaeopathological case in the world. Assessment of the facial structure faintly suggests acromegaly, which could indicate a regression of hyperpituitarism. In ancient times, no surgical or pharmaceutical treatment would be available; therefore, regression could only have resulted from degeneration of the pituitary gland. Infarction, a known clinical phenomenon in the modern world, could have occurred. The fact that he was buried with honours in an elite mastaba-tomb, after reaching adulthood, suggests that gigantism at the time was probably not associated with social margination. While short people were much preferred in ancient Egypt, especially in the early dynastic period, we have no records that very tall people had any special social preference or disadvantage. From all known royal mummies, no other king or queen fulfils the requirement of gigantism. In general, they were taller than commoners, but within the normal range.Inspection of the skeleton's sella turcica and genetic analyses might corroborate the present anthropometric diagnosis.

This report was funded by the Swiss National Science Foundation (The Canopic Jar Project - grant number 162803), the Mäxi Foundation, Zurich, Switzerland, and the Cogito Foundation, Zurich, Switzerland. We declare no competing interests. We thank Patrick Eppenberger (Institute of Evolutionary Medicine, University of Zurich) for helping with the graphics and Owen Burke (Aylesbury, UK) for his revision of the report.

Supplementary Material Supplementary appendix