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Turkish Journal of Sport and Exercise /Türk Spor ve Egzersiz Dergisi
http://dergipark.gov.tr/tsed
Year: 2020 - Volume: 22 - Issue: 1 - Pages: 48-56
DOI: 10.15314/tsed.685136
ISSN: 2147-5652
Anthropometric, Morphometric and Posture Evaluation
of The Tallest Living Person In The World: A Case Report
Erhan KARA1A
1 Namık Kemal University School Of Physical Education and Sports, Tekirdağ, TÜRKİYE
Address Correspondence to E. KARA e-mail: ekara@nku.edu.tr
(Received): 05.02.2020/ (Accepted): 06.04.2020
A:Orcid ID: 0000-0003-0727-5755
Abstract
This study aims to identify the anthropometric and morphometric characteristics and reveal the postural disorder of the male
case called S.K who was diagnosed with Gigantism (pituitary gigantism) caused by hypersecretion of pituitary tumor-related
growth hormone and entitled as the tallest person alive in the world with a height of 2.51 cm in the Guinness World Records in
2009. Height, weight, body mass index, upper extremity lengths, lower extremity lengths, skinfold thickness, upper and lower
extremity diameters, upper and lower extremity perimeters, chest depth and hand grip strength were measured for
anthropometric measurement. 8 different body segments were calculated and analyzed using The Posture Screen Mobile®
application for posture evaluation. Disorders in these segments were identified based on forwarding tilt of head
(Anterior/Lateral -AL), position of head (A-L), tilt and position of shoulder (A-L), position of ribcage (left-right), position of
pelvis (left-right), pelvic tilt (left-right) and load on the head (lb. and kg) (Figure 1.). The measurements revealed that the case
surprisingly had anthropometric and morphometric values above normal human dimensions and that, there was also no other
living human being with numerically the same values. (Table 2-8). As a result, since the fact investigated has an extreme length
due to gigantism, he has taken his place in the Guinness Book of Records as the world's lon gest living person with a long
length.
Key Words: The tallest human, gigantism, pituitary gland, posture, anthropometry
INTRODUCTION
Anthropometry refers to a set of systematic
measurement techniques used for measuring the
human body and skeleton sizes quantitatively (5). It
is generally considered as the conventional, and
perhaps, the main tool of biological anthropology.
All people on earth are from the same species;
however, none of them are exactly the same in terms
of measurable characteristics. A number of
differences are seen in all including genetically
identical twins (monozygotic). Such differences tend
to undergo changes over the period from birth to
death. Since skeletal development in times of health
and illness is affected by some factors based on
geographical differences, there are significant
differences between skeletal rates. Anthropometry is
another approach that refers to direct quantitative
expression of the shape of human body (20).
Moreover, anthropometric characteristics are known
to be directly related with to gender, shape and
form. The Internal structure of body and tissue
components are generated with the effect of
environmental and genetical factors (1).
Posture
It is defined as the combination of each
movement in the body and positions of joints that
create such movements, and is also considered as an
indication of the person’s body structure. Height is
regarded as one of the most important variables that
express the size of human beings (7). Height is
generally defined as distance, and expresses a
standing upright position starting from the sole up
to the top of head (23). Excessive increase in height
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that occurs before adolescence results in Gigantism,
also known as pituitary gigantism, caused by
hypersecretion of growth hormone (GH). (9).
Case
Officially entitled as the tallest living person on
earth in the “Guinness World Records” in 2009 with
a weight of 158 kg and height of 2 m and 46 cm,
thirty-seven-year-old male case named S.K., applied
to the hospital at the age of six with the complaints
of headache and loss of vision in left eye. The results
of the examination showed that he had a tumor in
his pituitary gland. He was diagnosed with
Gigantism (Pituitary Gigantism) due to
hypersecretion of growth hormone (GH) caused by
a tumor in pituitary gland (26). Acromegaly and
gigantism are considered as a quite rare condition
observed throughout the human history, which
typically results from chronical excessive generation
and secretion of growth hormone, and pituitary
tumor.
Some severe gigantism cases from past years in
literature are shown in Table 1. Since the increase in
height continued after the establishment of
diagnosis, the height was measured as 2.51 cm two
years later, and thus data in the Guinness World
Records was updated. The case also holds the record
for having the biggest hands in the world with 28.5
cm (left and right). The length of the foot is 35.5 cm.
(right), 36.5 cm. (left) and his shoe size is 60 (17). It
was found that a gamma knife surgery was
performed at the Virginia University, USA, in
August 2010, on the tumor affecting the pituitary
gland, which stopped the generation of growth
hormone and prevented the further increase in the
height successfully. This study aims to perform an
extensive analysis on the anthropometric parameters
of the case which were not measured previously, as
well as his posture (18).
Table 1. Cases of Excessive Jigantism that Started Growth in Early Childhood
Name
Coun try
Sex
Birth
Birth
Abnormal
Last height
Year
Weight
Gro wth Ag e
Measure
(kg)
(Year)
(cm)
Martin Van Buren Batesa
U.S.A.
M
1837
Normal
< 4
222
Anna Haining Swana
Canada
F
1846
8.1
< 4
227
Ella Kate Ewing
U.S.A.
F
1872
3,4
7
225
Fedor Andreevich Machnow
Russia
M
1878
*NA
5
239
Edouard Beaupré
Canada
M
1881
4,1
3
251
Joh(a)n Aasen
U.S.A.
M
1890
*NA
< 8
218
Albert Johan Kramer
Netherland
M
1897
8,5
< 7
238
Robert Pershing Wadlow
U.S.A.
M
1918
4,1
< 3
272
Cecil Boling
U.S.A.
M
1920
Normal
< 7
235
Rigardus Rijnhout
Netherland
M
1922
Normal
> 3
238
Sandra Elaine (Sandy) Allen
U.S.A.
F
1955
2.95
3
232
Dolores Ann Pullard
U.S.A.
F
1946
Normal
4
227
Zeng Jinlian
China
F
1965
Normal
< 1
249
Yao Defen
China
F
1972
2.8
< 3
234
M=Male F=Female NA=Not Applicable (2)
Ethics: A written consent was received from the case upon provision of detailed information about the study orally.
METHOD AND MATERIAL
Anthropometric Measurements
Height
The distance from the top of head to the floor
was measured in cm. at anatomic position using a
body tape measure that has a reel system and is
inflexible with a width of 7 mm. (19,21)
Body Weight
using a Tanita (model BC545N) scales with a
sensitivity of 100 gr. (19,21)
Body Mass Index
BMI (kg/m2) = weight (kg) / height (m2)
Measurement of Length of Upper Extremities
All length measurements were performed using
a body tape measure that has a reel system and is
inflexible with a width of 7 mm. (19,21)
Weight was measured with a naked top and
minimal clothing on the lowers part of the body
Turkish Journal of Sport and Exercise /Türk Spor ve Egzersiz Dergisi 2020; 22(1): 48 -56
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© 2020 Faculty of Sport Sciences, Selcuk University
Arm
The distance between acromion and olecranon
was measured using a body tape measure at
standing position with the arms parallel to the
ground and shoulder muscles and arms are relaxed
(19,21).
Forearm
The distance between olecranon and styloid
projection of distal radius was measured using a
body tape measure with the forearm parallel to the
ground at a 90º angle (19,21)
Hand length
The distance between the styloid projection of
radius and edge of the 3rd finger was measured
over the dorsum of the hand using an inflexible tape
measure (19,21).
Arm Span
The case was asked to lay on his back on the
floor and spread his arms, then the distance
between the edges of middle fingers of both hands
was measured using a tape measure (21).
Measurement of Length of Lower Extremities
Real Lower Extremity
Distance from the spina iliaca anterior superior
to inner malleolus using a tape measure (21).
Functional Lower Extremity
Distance between belly button and inner
malleolus was measured using a tape measure in
order to find the length difference of functional
lower extremity (21).
Thigh
Distance between the upper edge of patella and
center of inguinal ligament was measured using a
tape measure (12).
Leg
Distance between the tibial plateau and floor
was measured in standing position using a tape
measure (21).
Foot
Distance between the heel and longest toe was
measured laterally at standing position (21)
Skinfold Thickness
Measurement was performed using a Holtain
skinfold caliper. For the reliability purposes,
Erhan KARA Orcid ID: 0000-0003-0727-5755
measurement was performed from between the
thumb and index finger at a location 1 cm. away
from the measurement point. Two measurements
were performed on each region taking care to keep
the holding pressure the same until the end of
measurement. There was a waiting period between
two measurements. All measurements were
performed on the right side of the body while the
case was at standing position. Skinfold
measurement was performed on a total of 7 regions.
These are listed as follows (19,21).
Chest
It was performed at the middle point of
distance between nipple and front axillar line.
Subscapular
It was measured diagonally from under the
scapula at an angle of 45º.
Axillary
Measurement was performed parallel to the
ground at the intersection point of xiphoid
projection under sternum and middle axillary line.
Triceps
A vertical measurement was performed at the
middle point between acromion and olecranon with
the elbows extended and arm muscles relaxed and
close to the body.
Abdominal
A vertical measurement was made laterally
from a point that is 2-3 cm. under the belly button.
Suprailiac
It was measured diagonally from the top of
crista iliaca at an angle of 45º.
Diameter Measurements
For the diameter measurements of case,
anthropometric caliper was used; pressure was
applied as the arms of caliper compressed the soft
tissue, and diameter was measured from between
specific bone projections at a total of 7 regions.
These are listed as follows (21).
Shoulder
Ends of caliper were placed on the most
swollen part of the deltoid muscle, and
measurement was performed at standing upright
position with arms free on the sides.
Turkish Journal of Sport and Exercise /Türk Spor ve Egzersiz Dergisi 2020; 22(1): 48 -56
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© 2020 Faculty of Sport Sciences, Selcuk University
Biacromial
Arms of caliper were placed on the lateral
points of acromion projection and measurement was
performed at standing position with arms free on
the sides by determining the maximal width from
posterior.
Elbow
Distance between the lateral and medial
epicondyles of humerus was measured at 90º flexion
and forearm supination position by applying a little
pressure.
Wrist
Length between the styloid projection of radius
and ulna was measured.
Bitrochanteric
Erhan KARA Orcid ID: 0000-0003-0727-5755
Neck
Measurement was performed at anatomic
position from the narrowest point under the thyroid
cartilage (21).
Shoulder
Measurement was performed on the most
swollen part of the deltoid muscle at standing
upright position with shoulder muscles relaxed and
arms free (21).
Arm
The middle point between acromion and
olecranon was marked at standing position, and
measurement was performed on the most swollen
point of the muscle (21).
Forearm
With the arms free and close to body, arms of
the caliper were placed on the lateral parts of
acromion, and maximum width was measured and
recorded with pressure on the soft tissue.
Biiliac
Measurement was performed from posterior at
standing position with arms crossed on the chest
and ends of the caliper on crista iliac so that they
form a downward angle of 45º.
Knee
At sitting position with 90º knee flexion, ends of
the caliper were placed on the medial and lateral
condyles of femur, and the distance in-between was
measured by pressing firmly.
Ankle
Measurement was performed at a standing
upright position by placing the caliper ends on the
projected points of medial and lateral malleolus.
Circumference Measurements of Upper and
Lower Extremities
All circumference measurements were
performed using a body tape measure that has a reel
system and is inflexible with a width of 7 mm. (21)
Head
The distance between the most projected point
of occipital bone and the most projected point over
the eyebrows was measured (21).
Arms were dropped down, and measurement
was performed on the most swollen point of the
muscle based on the styloid projection of ulna bone
(21).
Wrist
Distance between the distal styloid projection of
olecranon and radius bone was measured at 90º
flexion with palms facing each other (21).
Chest
Measurement was performed at the xiphoid
projection right under the axillar region in normal
respiration phase with the feet spread at shoulder
width and arms in abduction (21).
Abdomen
Measurement was performed over the belly
button with the tape parallel to the floor and not
compressing the tissues (21).
Hip
Tape measure was placed on the widest part of
hip parallel to the floor without compressing the
tissues (21).
Thigh
With 90º knee flexion, proximal end of inguinal
region and patella was marked, and measurement
was performed on the most swollen point of muscle
(21).
Turkish Journal of Sport and Exercise /Türk Spor ve Egzersiz Dergisi 2020; 22(1): 48 -56
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© 2020 Faculty of Sport Sciences, Selcuk University
Knee
Measurement was performed on the middle line
of patella after one knee was bended slightly and body
weight was transferred to the other knee (21).
Leg
The case sat on a high armchair so that his legs
dropped down and spread his feet for about 20 cm,
then the measurement was performed 10-15 cm over
the medial malleolus without compressing the
tissues (21).
Ankle
At upright position with bare feet, tape measure
was placed on the top of malleolus and the thinnest
part of ankle, and measurement was performed
without compressing the soft tissue (21).
Chest Depth
At standing position, measurement was
performed at the intersection point of 3rd and 4th
sternum on the left side of case by placing one end
of a wide-spread caliper on the sternum and the
other end on the spinous process at the back (8).
Hand Grip Strength
A Cambry (Model EH101) digital hand
dynamometer was used, which was capable of
measuring strength between 5.0 and 100 kg. With
arms having an angle of 10º -15º from shoulders,
grip strength of the dominant hand was measured
in rested state. Measurements were performed on
the dominant hand only, and the best value after
two trials was considered as the grip strength (21).
Posture Evaluation
Posture analysis of patient was performed using
the analysis application called PSM (The
PostureScreen Mobile®) which was tested for
validity in previous studies with positive results
(10,11,13,26). PSM application performs the analysis
by making angular calculations and marking the
anatomical reference points on the photos of the
posture variables on sagittal-coronal plane in
anterior and lateral (right) directions taken using the
camera of an iPad® tablet with the upper body
naked and in neutral position. The male case named
S.K. had a loss of balance during standing static
posture position since multiple right tibia bones
were fractured before. Therefore, his photos were
taken while he was standing using a walking stick.
Afterwards, PMS application performed an analysis
of posture variables. Moreover, this application can
Erhan KARA Orcid ID: 0000-0003-0727-5755
also guide the user on how to digitalize the specified
anatomical reference points. These reference points
are as follows on the anterior side; right and left
pupils, middle point between the nose and upper
lip, top point of right and left acromioclavicular
(AC) joint, right and thoracal (T8) over sternum
(episternal notch), right and left anterior superior
iliac spine (ASIS), and the middle point of right and
left ankle joints. A total of five anatomical reference
points were marked for lateral posture analysis;
tragus of ear, cervicothoracic area on the middle line
of shoulder, greater trochanter, tibiofemoral joint
and middle line of lateral malleolus. Then the PSM
application performed the calculation and analysis
of 8 different body segments by using proprietary
algorithms (Figure 1). These segments are forward
tilt of head (Anterior/Lateral -AL), position of head
(A-L), tilt and position of shoulder (A-L), position of
ribcage (left-right), position of pelvis (left-right) and
pelvic tilt (left-right). Application also calculated the
load on the head (lb and kg).
Turkish Journal of Sport and Exercise /Türk Spor ve Egzersiz Dergisi 2020; 22(1): 48 -56
52
© 2020 Faculty of Sport Sciences, Selcuk University
Erhan KARA Orcid ID: 0000-0003-0727-5755
RESULTS
Table 2. Height, Weight, Age, BMI
Height (cm)
Weight (kg)
Age (years)
*BMI (kg/m
2
)
2.51
158
37
25.1
*Body Masss Index
Table 3. Measurement of Length of Upper Extremities (cm)
Arm (Right)
Arm (Left)
Forearm (Right)
Forearm (Left)
Hand (Right)
Hand (Left)
Arm Span
121
121
47
47
28,5
28,5
2,72
Table 4. Measurement of Length of Lower Extremities (cm)
Real Lower
Real
Functional
Functional
Thigh
Thigh
Leg
Leg
Foot
Foot
Extremity
Lower
lower
lower
(Right)
(Left)
(Right)
(Left)
(Right)
(Left)
(Right)
Extremity
extremity
extremity
(Left)
(Right)
(Left)
13.4
13.8
14.2
14.9
59
62
59
63
35.5
36.5
Table 5. Skinfold Thickness (mm)
Chest
Subscapular
Axilla
Triceps
Abdominal
Suprailiac
Thigh
15
14
17
13
24
9
18
Table 6. Diameter Measurements (cm)
Shoulder
Biacromial
Elbow
Wrist
Biiliac
Bitrochanteric
Knee
Ankle
50.8
31.7
40
34
36.6
40.3
48
60
Table 7. Upper and Lower Extremity Perimeter Measurements (cm)
Head
Neck
Shoulder
Arm
Forearm
Wrist
Chest
Abd.
Hip
Thigh
Knee
Leg
Ankle
68
46
141
37
36
27
126
127
133
55
48
30
29
Abd: Abdominal
Table 8. Chest Depth (cm) and Hand Grip Strength Measurements (kg)
Chest Depth
Handgrip Strength
22.1
65.3
Turkish Journal of Sport and Exercise /Türk Spor ve Egzersiz Dergisi 2020; 22(1): 48 -56
53
© 2020 Faculty of Sport Sciences, Selcuk University
Erhan KARA Orcid ID: 0000-0003-0727-5755
Figure 1. Posture Evaluation
DISCUSSION
Starting from the ancient ages, acromegalic and
gigantic individuals with extraordinary
anthropometric sizes have been the subject of many
mythological stories (4). The male case in this study
named S.K, has an anthropometric and morphologic
structure that is over the normal human sizes (Table
2-8). It is also seen that he suffers from tibial
shortness due to two right tibia fractures (right 59
cm and left 63 cm. Table 4). Gigantism occurs when
open epiphyseal growth plates allow for linear
growth due to secretion of excessive GH in
childhood whereas acromegaly is a condition that
occurs in adulthood (6). Growth and development
are affected primarily by gens, hormones,
nutritional sources, environmental and cultural
interaction as well as combination of other factors
(6). As an important element of growth and
development, development of skeletal system is
mainly controlled by the growth hormone that is
produced in pituitary gland (24). Anomalies such as
tumor malformation, hyperplasia or traumatic
destruction affect the pituitary gland, and therefore
Turkish Journal of Sport and Exercise /Türk Spor ve Egzersiz Dergisi 2020; 22(1): 48 -56
54
© 2020 Faculty of Sport Sciences, Selcuk University
growth hormone may cause hyperpituitarism (22).
According to the literature review, some of the
people that were entitled as the tallest person in the
world, whether gigantic or not, are as follows:
Robert Wadlow (The Alton Giant) took a part in the
book of “Guinness” records as the tallest person of
all times after his death with a height of 8 feet 11
inches (2.72 cm) and weight of 272 kg. (6). Joseph
Edouard Beaupre was born in 1881 in Saskatchewan,
Canada, and died in 1904 at the age of 23 as a
pituitary tumor related gigantic person with a height
of 252.9 cm and a weight of 170 kg. (14). Leonid
Stepanovych Stadnyk (1969-2004) put his stamp in
history with a height of 2.57 cm resulting from a
tumor in his pituitary gland (15). Väinö Myllyrinne
(1909–1963) is known to have had a height of 2.24
cm and a weight of 141 kg. (16). It is also known that
there are people recorded as the tallest in the book of
“Guinness” records who are still alive today. They
may be listed as follows: Brahim Takioullah, born in
1982 in Morocco, is 2.46 cm tall and has the
diagnosis of acromegaly (16). Born in 1987 in Iran,
Morteza Mehrzad Selakjani is known as the second
tallest living person in the world with a height of
2.47 cm resulting from acromegaly (16). Born in
1983, Dharmendra Pratap Singh has officially been
recorded as the tallest living person in India (16).
Zhang Juncai was born in 1966 in the People’s
Republic of China, and is among the tallest living
people in the world with a height of 2.42 cm. (16).
Born in 1988, Asadulla Khan has also attracted
attention in India with a height of 2.41 cm. (16). Born
in 1975 in Pakistan, Naseer Soomro is 2.38 cm tall.
(16) Chinese athlete Sun Mingming was born in 1983
and is entitled as the tallest basketball player in the
world (16).
As a result, the fact that anthropometric,
morphometric and posture structures of the male case
called S.K were not evaluated extensively before led to
the need to perform the required researches and reveal
data. The studied case was diagnosed with gigantism
due to secretion of growth hormone above normal
levels caused by a tumor in pituitary gland. The
increase in his length continued with the increased age,
and could not be stopped until a certain age. Therefore,
it was seen that he had quite higher sizes as compared
to the anthropometric and morphometric structure of a
healthy individual resulting with a posture disorder.
Erhan KARA Orcid ID: 0000-0003-0727-5755
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