Genetics and Hormones (GGH) has been published without
interruption for the past 19 years. This journal was conceived and founded
in 1984 by Dr. Robert M. Blizzard; the first issue appeared in March 1985.
The goal set by him and the editorial board was to integrate reports of
current advances in the fields of growth, genetics, endocrinology,
metabolism and nutrition by bringing the most pertinent papers, with
erudite editorial comments, to the attention of pediatricians, internists,
pediatric endocrinologists, geneticists, nutritionists, nurses, and to
others interested in these fields.
As Editor-in-Chief, Dr. Blizzard has worked tirelessly since the
inception of the journal. He has been personally responsible for
selecting, recruiting and stimulating the editorial board. He has elicited
the best from all of us. Initially the editorial board consisted of Drs.
David L. Rimoin, Fima Lifshitz and Alan Rogol from the United States,
Judith G. Hall from Canada, and Dr. Jürgen R. Bierich as a European
representative. Subsequently other distinguished Pediatric
Endocrinologists from Europe joined the editorial board, including Drs.
Jean-Claude Job and James Tanner. The current editorial board members,
serving GGH since 1993, are Drs. William Clarke, William Horton,
and Allen Root, plus founding members Judith G. Hall and Fima Lifshitz.
Dr. Blizzard has spearheaded all aspects of the publication including the
content, quality, and format.
Throughout the last 19 years GGH has exceeded his goals and has
become a well established resource for all 6,000 of its current readers,
many of whom cherish the journal and keep each issue in their reference
libraries. As well, Dr. Blizzard has made sure that as the cycle of life
continues there would be a positive and productive transition for GGH.
During the past two years he has fostered a smooth passage to ensure that
upon completion of his tenure as Editor-in-Chief the journal will continue
to serve the needs of our colleagues and continue to grow. He personally
has overseen all transitional aspects and bestowed responsibility for the
future of GGH to me as Editor-in-Chief.
Dr. Blizzard requested that a short announcement be inserted about his
retirement in this his last issue Vol. 19 No. 4. He wished to see that the
many readers who have read GGH throughout the years were thanked
and appreciation was expressed to all those who have contributed to GGH
by writing lead articles and to those who have been consistent readers. We
pass this message along for him, and the editorial board joins him in
saying "thank you".
The editorial board, wishing to acknowledge the many years of service
and the most important contributions of Dr. Blizzard, has prepared a brief
outline of the accomplishments of this founding editor, teacher, pediatric
endocrinologist, clinician, scientist, and man described below. This
tribute to him is but a token way to bid him farewell and to imprint his
legacy, so that future generations of our colleagues also may be inspired
First and foremost, Dr. Blizzard will be remembered and recognized as a
teacher and educator. He is an accomplished teacher, and his competence as
an educator and preceptor is well known. He was trained (1955-1957) by
Lawson Wilkins and he was "trained to train", when there were only
approximately 20 pediatric endocrinologists in the country. He prides
himself in being a pediatric endocrinologist for 48 years (1955-2003) and
throughout his career he set the course for his students. Over 50 fellows,
including myself and other members of the editorial board, undertook and
completed their training with him. Forty-five of these are now in academic
positions. Many are full professors including three deans, an associate
vice president for health affairs, several chiefs of staff of children’s
hospitals, and several pediatric department chairpersons in the U.S. and
abroad. He is proud of the fact that most of his fellows have established
their own pediatric endocrinology training programs, and thus provided an
ongoing transmission of the teaching of Lawson Wilkins and himself to
second and third generations of pediatric endocrine fellows. He has
received multiple teaching awards including those from the Johns Hopkins
Hospital, the University of Virginia, and other prestigious universities.
Very possibly the teaching award of which he is most proud is his election
to alpha omega alpha in 1970 by the members of the Johns Hopkins Alpha
Omega Alpha (AOA) Society. His accomplishments as a student had not
qualified him for AOA membership, and, therefore, his election by the
student membership was particularly gratifying, since only one faculty
member per year was elected to the society.
He also is proud of the opportunity to have served as Acting Chairman
of the Department of Pediatrics at the Johns Hopkins University School of
Medicine (1972 and 1973) and as Chairman of the Department of Pediatrics
at the University of Virginia, School of Medicine (1974-1987). At these
institutions he fostered 15 generations of pediatric residents who sought
and attained their pediatric training in his departments. Most of them are
now in academic and/or clinical practice in the US. A significant number
are abroad. For his educational activities he has been honored with other
prestigious awards. Among them are the Ayerst (1973) and Williams (1994)
distinguished service and leadership awards bestowed by the American
Endocrine Society. Recently he has been honored to be elected to the Johns
Hopkins Society of Scholars (2002) and honored by the establishment (2002)
of the Robert M. Blizzard Annual Lectureship at the annual meetings of the
Lawson Wilkins Pediatric Endocrine Society (2002). He also has been
honored by invitations to deliver over 150 named lectureships and visiting
professorships at many national and international academic institutions.
He was elected to the prestigious Hall of Fame of Miami Children’s
Hospital in 1997. Those who attended the teachings of Dr. Blizzard have
always recognized his talents in teaching, and most have asked for more!
However, his contributions as an educator transcend the traditional
teaching role through which be personally touched so many individuals and
imparted his knowledge. Dr. Blizzard made major contributions to
continuing medical education by serving on multiple editorial boards of
journals, editing and publication of several textbooks, and by his 19
years of editorship of GGH. The number of physicians and other
scientists whom he reached via this journal through the years cannot be
easily counted nor measured, but GGH is currently read regularly,
as previously stated, by over 6,000 colleagues world-wide. Thus, the
impact of Dr. Blizzard as an educator can be summarized as "the teacher
In the field of endocrinology, he is particularly known for his
contributions in the areas of growth and in autoimmunity, with over 200
original peer-review papers published in the literature. His
picture is a clear testimony to his
legacy as a clinician. He has always, in the Wilkins’ style, promoted
accurate measurements of children in assessing growth. This is still the
gold standard in the evaluation of children with short stature. Dr.
Blizzard was a pioneer in this field, publishing his first studies on the
action of human growth hormone in 1959, one year after the first
publication by Dr. Raben of the use of human growth hormone in growth
hormone deficient individuals. His interest continues in this field to
this day. Dr. Blizzard, along with Dr. Joanne Brasel and Dr. James Wright
in the early 1960s published several important papers that changed the
approach to the diagnosis and treatment of growth hormone deficiency.
Included were the observations that growth hormone deficiency can be
manifested by delayed growth even in the first year of life, previously
not thought to be the case, and that the acute metabolic response to human
growth hormone did not correlate with its growth promoting effects when
growth hormone deficient children were treated. The search for reliable
indicators to predict a quantitative response to growth hormone is still
Subsequently, Dr. Blizzard authored or co-authored 56 publications in
peer-review journals pertaining to growth hormone or growth factors. These
studies clarified the role that growth hormone played in producing the
adolescent growth spurt, and the phenomenon of growth hormone production
and its relationship to steroid production during this stage of life. A
series of articles published under his tutorage unequivocally demonstrated
that growth hormone increases at the time of adolescence when testosterone
is produced in males. These studies showed that growth hormone and
testosterone each have separate mechanisms of action in promoting growth,
as well as permissive actions in the relationship to the secretion of each
In 1971 Dr. Blizzard stimulated his associates to design a pump that
would permit a constant withdrawal of blood over a 24-hour period, that
would permit the measurement of integrated concentrations of circulating
hormones. Dr. Avinoam Kowarski was successful in this endeavor, and he and
Dr. Robert Thompson, Dr. Claude Migeon, and Dr. Blizzard first reported
the determination of integrated concentrations of human growth hormone and
true secretion rates of human growth hormone. The importance of
pulsatility and the intricacies of growth hormone production at various
stages of life were subsequently delineated using this technique in
studies with Dr. Alan Rogol, Dr. Paul Martha, Dr. Nelly Mauras, Dr.
Kathleen Link, and others at the University of Virginia.
While being a leader throughout his life and an innovative initiator of
investigative protocols, he appropriately was appointed Director of the
Clinical Research Center at the University of Virginia (1980-1983), while
serving simultaneously as Department Chairman. He collaborated extensively
with his colleagues in the Divisions of Endocrinology in Internal Medicine
(Dr. Michael Thorner in particular among others). He coauthored 15 papers
concerning the effect of growth hormone releasing hormone in humans - both
as a diagnostic and therapeutic agent.
Although not as well known, Dr. Blizzard initiated and significantly
contributed in elucidating the possible role of decreased growth hormone
production during adult life in the aging process. He, his associate Dr.
Ann Johanson, and his group initially demonstrated that older males
secrete less growth hormone than do young males, and that older males
receiving growth hormone retain nitrogen, comparable to that seen in
growth hormone deficient young adults. They also reported that growth
hormone administered to older males generated insulin-like growth factor
I, comparably to that generated in growth hormone deficient children. He
subsequently described the changes in pulsatility of growth hormone
secretion in older men and women as compared to younger subjects.
These studies led to the involvement of Dr. Blizzard in the first study
to evaluate the effect of chronic growth hormone administration in older
males. His research was not only at the intellectual/research level; he
was the first of five males in a study which he initiated to receive
growth hormone every day over a period of 30 months. He and his colleagues
demonstrated that growth hormone had no significant effect upon skin
collagen and its amino acid composition. He was obliged to stop the study
in 1985 because of the report of possible contamination of native
pituitary extracts by the prion producing Creutzfeldt-Jakob disease.
However, the results of this project undoubtedly stimulated other
investigators to assess the effect of growth hormone in the elderly.
Another major contribution of Dr. Blizzard was the concept that
psychosocial dwarfism (also called emotional deprivation, maternal
deprivation, the garbage can syndrome, and reversible hyposomatotropism)
resulted from transient growth hormone deficiency. He insists that major
credit in the concept be accepted by Dr. Dagfinn Aarskog, Dr. Gerald
Powell, Dr. Salvatore Raiti, and others. The demonstration of the patho-physiology
of such alterations gave great impetus to studying how the hypothalamus
and its neurotransmitters are controlled by higher cerebro-cortical
centers which has been the subject of countless studies. To date Dr.
Blizzard continues to be considered a world authority on psychosocial
dwarfism or reversible hyposomatotropism.
Although currently known by young pediatric endocrinologists and
academicians more for his work in the field of growth, he contributed
significantly in other fields of endocrinology. In 1959 he initiated a
study to determine aldosterone excretion in virilizing adrenal
hyperplasia. He was the lead author of an article in the Journal of
Clinical Investigation demonstrating that salt-losing congenital
virilizing adrenal hyperplasia was due to decreased aldosterone secretion.
Between 1955 and 1980 Dr. Blizzard was a leading international
investigator and authority on autoimmune endocrine diseases. He suggested
that many endocrine diseases characterized by glandular atrophy, including
adrenal insufficiency, hypoparathyroidism, premature ovarian failure, and
insulin dependent diabetes mellitus were of autoimmune origin. He studied
this model in his laboratory over the next 25 years and applied his
findings in the clinic setting which led to publications of 27 papers in
In his laboratory with the assistance of Dr. Robert Chandler, he was
one of the first investigators to demonstrate that Addison’s disease was
frequently of autoimmune origin and the first to elucidate the physical
and biochemical characteristics of the antigens involved. In 1966 he
reported that hypoparathyroidism was also related to antibody formation.
In 1960 he had demonstrated that there was a high incidence of antibodies
against thyroid microsomes and thyroglobulin in the serum of mothers of
athyreotic cretins. Dr. Blizzard postulated that autoimmune thyroid
disease in the pregnant woman might be the etiology of at least some cases
of congenital athyreotic cretinism. At the Pediatric Endocrine Research
Meetings in May 1987, Dr. Dussault of Canada presented confirmatory
evidence of this hypothesis, and acknowledged that the concept and early
data had been presented by Dr. Blizzard years previously.
In the early 1960’s he proposed that some cases of insulin dependent
diabetes mellitus were probably of autoimmune origin with destruction of
the beta cells of the pancreas. This observation was based on his earlier
papers reporting the associations of diabetes mellitus with Addison’s
disease and hypoparathyroidism. In 1961, he submitted a grant to the
National Institutes of Health (NIH) proposing to study this concept. The
grant was rejected stating that the concept was preposterous; subsequently
it was demonstrated that indeed many patients with insulin dependent
diabetes mellitus had antibodies to beta cells and the role of
autoimmunity in insulin dependent diabetes mellitus was firmly
Even subsequent to 1979, when Dr. Blizzard was devoting the majority of
his investigative time to problems of growth, he published major papers
concerning autoimmunity. These papers further elucidated the associations
of various types of autoimmune diseases, and particularly clarified the
associations of the various types of polyglandular autoimmune adrenal
disease with other endocrine disorders. At an international autoimmune
conference held in Pisa, Italy, in 1979, Blizzard proposed a
classification of polyglandular autoimmune diseases, which was accepted
internationally and continues to be used today with only minor
Blizzard has recorded many other "firsts" in the field of pediatric
endocrinology, including, with the collaboration of Dr. Ann Johanson and
Dr. Harvey Guyda and other fellows, the elucidation of the intricacies of
luteinizing hormone and follicle stimulating hormone secretion during
childhood and puberty, and the abnormalities found in sexual precocity. In
his laboratory, along with Dr. Robert Penny, he demonstrated that
gonadotropin levels were elevated in hypothyroid children who have
associated sexual precocity. He reported with Dr. Johanson that patients
with gonadal agenesis or Turner syndrome grew significantly when treated
with anabolic agents.
Other firsts included a description and report of the Johanson-Blizzard
syndrome of congenital anomalies in congenital hypothyroidism and a
description of the syndrome of congenital adrenal
cortical-unresponsiveness to ACTH with Dr. Claude Migeon. In addition, Dr.
Blizzard actively contributed to and participated in the treatment and
research of patients with central sexual precocity utilizing gonadotropin
releasing hormone agonists (GHRHa) to block pubertal development. Dr.
Blizzard was proud of his capability to work collegially and
collaboratively with others to promote multicenter investigation. An
example was his collaboration over several years with Dr. Paul Boepple,
Dr. William Crowley, and others in Boston in studying the role of GnRH
In 1961, in association with Dr. Alfred Wilhelmi, Chairman of the
Department of Biochemistry at Emory University, the National Pituitary
Agency was established. The purpose of this agency was to collect human
pituitaries at autopsy examination, extracting their hormones, and to
distribute these hormones on a national basis for investigation and
therapy. He organized this collection and distribution program under the
auspices of the (NIH), and was the Director of the agency until 1967. Dr.
Blizzard inspired and led a lay group of individuals to develop an
organization of parents and others to assist in the collection of human
pituitary glands. Their success led to the establishment of the Human
Growth Foundation in 1965. The scope of this organization grew and
eventually became a support source for families of children with growth
disorders with chapters across the country and with an ability to fund
research in the area of growth disorders. After the National Pituitary
Agency and The Human Growth Foundation were firmly established, Dr.
Blizzard was followed by Dr. Salvatore Raiti, one of his former fellows,
as director. It was this program that led to, and made possible, all of
the investigation pertaining to pituitary hormones that occurred in humans
in the subsequent 24 years (1961-1985) before synthetic growth hormone
In 1993 he was asked to establish the Genentech Foundation for Growth
and Development, a grant awarding organization separate from Genentech
Inc., with an independent board and decision making authority. In the 8 ½
years of its existence under his leadership this foundation provided more
than $18 million dollars in grants to clinical investigators, to basic
science investigators, to physicians receiving training in the fields of
growth and development, and to support professional and personal education
of growth and development in these fields.
Discussing the many contributions of Dr. Blizzard to pediatrics and to
science is an easy and enjoyable endeavor, particularly because he always
attempted to recognize the contributions of those with whom he worked
professionally. Examples of his appreciation for professional collegiality
and recognition are cited in the text above. A major professional
colleague of Dr. Blizzard and contributor to the success of Growth,
Genetics & Hormones for 19 years is Ms. Juanita Bishop, his trusted and
dependable assistant of over 20 years.
Describing the human qualities of Dr. Blizzard also is an easy and
enjoyable endeavor. He is an exceptional human being, and it is worth
noting the comforting way he talked to his patients and families and his
ability to put them at ease despite their difficult problems. He has a
special skill to develop closeness with others lasting a lifetime, and to
nourish and support his patients, students, fellows, and associates. This
is what I and his other associates appreciate the most!
The cycle of life continues, with the publication of this issue Dr.
Robert M. Blizzard has officially retired from the editorship of GGH.
He has had a most prestigious and distinguished career with enough
accomplishments for many lifetimes. He now plans to enjoy more time with
his family. We anticipate he will continue that which he does best,
inspiring and teaching. As he has thanked so many of us, we thank him for