A FAMILIAL ASPECT TO GOLIATH’S GIGANTISMGoliath, the Gittite, is the most well known giant in the Bible. He is described
as ‘a champion out of the camp of the Philistines, whose height was six
cubits and a span’ (Samuel 17:4). From Samuel and Chronicles (table I), we have drawn Goliath's pedigree (figure 1). A literal interpretation of the verses suggests that his brother and
three sons were also of giant stature. The name of Goliath's third son
does not appear in the Bible, so we have named him Exadactylus as it was
said that ‘he had on every hand six fingers, and on every foot six
toes’ (Samuel 21:20-21). Goliath's family tree is suggestive of a
hereditary autosomal dominant pituitary gene, such as AIP².
Table I
Bible references for the relatives in figure 1
Fig 1
Goliath's Pedigree. Affected members are shaded in black. + symbol indicates exadactyly.
Goliath was killed by David who threw a stone at his forehead (Samuel 17:49).
This gives further evidence that he suffered from pituitary gland
dysfunction; a pituitary tumour pressing on his optic chiasm, and
consequent visual disturbance due to pressure on his optic nerve, would
have made it difficult for him to see the stone in his lateral vision.
Pituitary giants look impressive in terms of stature, but may not have
speed and agility to match their perceived strength. David, having
agility, particularly having declined the heavy set of armour that was
offered to him, and being skilled at sling shots, may have found a way
around the fearsome looking giant by firing a sling shot from the side
of the battlefield. The fact that Goliath may have had a pituitary
tumour was recognised by Vladimir Berginer in a paper in 2000³. In his description of the condition, he notes a painting of David and
Goliath by Puget in the 18th century noting the appearance of acromegaly
in the severed head of Goliath, and remarks that the painting was done
more than one hundred years before Marie originally described the
condition in 1886. He also helpfully comments that Goliath was killed by
David severing his head, not from the impact of the stone which felled
him, possibly due to brain contusion, but did not actually kill him
directly.
Gigantism results when a growth hormone-secreting pituitary adenoma is present before epiphyseal fusion.
Pituitary adenomas can be present in a number of genetic conditions,
such as multiple endocrine neoplasia type 1, Carney complex, and
Familial Isolated Pituitary Adenoma (FIPA). FIPA is an autosomal
dominant condition with incomplete penetrance, caused by germline
mutations of the aryl hydrocarbon receptor interacting protein (AIP)
gene4. Patients with AIP mutations have an earlier mean age at diagnosis
than AIP mutation-negative patients⁴. The age of Goliath is not clear, but early onset of pituitary tumours
is typical of hereditary gigantism and limitation of lateral vision is
common. Goliath himself had a shield bearer precede him, possibly to
indicate to Goliath the direction of the approaching foe.
Polydactyly has not been described in association with FIPA. The AIP gene lies on
chromosome 11q13.3. The Bardet-Biedl gene, BBS1, is located close by on
chromosome 11q13.2. Bardet-Biedl syndrome type I is characterized by
rod-cone dystrophy, truncal obesity, cognitive impairment and postaxial
polydactyly⁵. The protein encoded by BBS1 is thought to play a role in limb
development. It is unlikely that Goliath's family had FIPA caused by a
microdeletion which also involved BBS1, as the genetic distance between
the BBS1 and AIP genes is separated by a 1 Mb gene-packed region. Such a
gap makes an inherited contiguous gene syndrome unlikely as there would
have been too many other features. Very rarely BBS1 patients have
symmetric exadactyly; most commonly it is present in one or two
extremities, upper and lower-not in all four. We are not given much
other detail about Exadactylus so a new BBS1 mutation due to some
complex rearrangement is unlikely-a new mutation in an autosomal
dominant polydactyly gene might explain his symmetrical phenotype. If he
had pituitary disease and six digits-he may have looked an intimidating
foe-but he may not have been a great warrior in action.
Interestingly, the book of Samuel refers to five stones that David carefully selected
for his sling from the nearby stream, and further reading of the
surrounding passages shows that David's relatives were all involved in
the deaths of the other giants in Goliath's family. There can be other
interpretations for this and various types of symbolism, but it appears
likely that several giants may have been from Goliath's family, further
suggesting autosomal dominant inheritance. The reverse also almost
happened-Ishbibenob, Goliath's son, is credited with almost killing
David until the swift intervention of David's nephew Abishai (2 Samuel
21.16), so clearly intellect or agility was not deficient in some of the
giants, and myopathy seen in some cases of pituitary disease in later
life, not a direct issue in the younger giants.