Leonardo da Vinci: the Lady with an Ermine enigma
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HISTORICAL NOTE
Leonardo da Vinci: the Lady with an Ermine enigma Andrea Sisti 1 & Payam Sadeghi 1 Received: 4 October 2020 / Accepted: 16 November 2020 # Hellenic Endocrine Society 2020
Abstract “Lady with an Ermine” (1489–1490) is an oil on walnut portrait by the Italian artist Leonardo da Vinci. The portrait’s subject is Cecilia Gallerani, the favorite mistress of Ludovico Sforza, known as “il Moro”, Duke of Milan. It was painted around the time of Cecilia’s pregnancy with Ludovico’s illegitimate son. Leonardo’s paintings are famous for hiding mysteries; thus, the truth about the “Lady with an Ermine” is still unclear. However, the solution to this enigma could be more evident than expected. Our hypothesis is that Cecilia might have suffered from pregnancy-induced Cushing syndrome. Keywords Pregnancy-induced Cushing Sindrome . Lady with an Ermine . Leonardo da Vinci . Portrait
“Lady with an Ermine” (1489–1490) is an oil on walnut portrait by the Italian artist Leonardo da Vinci, which is currently kept in the Czartoryski Museum, Kracow, Poland. The portrait’s subject is Cecilia Gallerani, painted around the time of Cecilia’s pregnancy with the illegitimate son of Ludovico Sforza, Duke of Milan [1]. Leonardo’s paintings [2] are famous for hiding mysteries [3], and the attribution of endocrinological diseases to subjects painted by Leonardo is not new [4, 5]. The truth about the “Lady with an Ermine” is still unclear, but the solution to this enigma could be more evident than expected. Our hypothesis is that Cecilia might have suffered from pregnancy-induced Cushing syndrome (CS), and, in fact, clinical signs and specific features of this syndrome are manifested, such as the buffalo hump on the back, thin arms, and moon-like facies (Fig. 1). As eloquently explained by Chaudhry and Singh in a recent review [6], CS is caused by prolonged exposure to high circulating levels of cortisol. The most common cause of cushingoid features is iatrogenic corticosteroid use, while some herbal preparations can also increase circulating corticosteroid levels, leading to CS. The disorder can interchange-
* Payam Sadeghi [email protected] 1
Department of Plastic Surgery, Cleveland Clinic Main Campus, Crile Building, 6th Floor, 9500 Euclid Ave, Cleveland, OH 44195, USA
ably be called hypercortisolism. ACTH-dependent cortisol excess due to a pituitary adenoma is called Cushing disease, and it is responsible for 80% of endogenous CS. Pregnancy-induced CS is rare, with an incidence rate of 2–25 per million per year in the general population [7]. The etiology of CS during pregnancy has been attributed to the aberrant-luteinizing hormone (LH)/human chorionic gonadotropin (hCG) receptor (LHCGR) [8]. Pregnancyinduced CS has indeed been frequently reported due to an adrenal neoplasm [9]. Since adrenal gland tumors occasionally respond to LH or hCG, these hormones might be responsible for the excessive growth and function of the tumor during pregnancy. It seems that LHCGR has an important role in the pathogenesis of pregnancy-in
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