April 13, 2007

Genetic clues to famous feud

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Wallace Neblett, M.D., chats with adrenal surgery patient Winnter Reynolds, 11, and her parents, Rita and James Reynolds. The family is related to the McCoy side of the legendary Hatfield-McCoy feud. (photo by Mary Donaldson)

Genetic clues to famous feud

Wallace Neblett, M.D., left and surgical resident James Broome, M.D., remove a tumor from Winnter Reynolds’ adrenal gland. (photo by Susan Urmy)

Wallace Neblett, M.D., left and surgical resident James Broome, M.D., remove a tumor from Winnter Reynolds’ adrenal gland. (photo by Susan Urmy)

Winnter Reynolds flashes the victory symbol during a follow-up visit. (photo by Mary Donaldson)

Winnter Reynolds flashes the victory symbol during a follow-up visit. (photo by Mary Donaldson)

Winnter Reynolds may have within her body a clue to the legendary Hatfield-McCoy feud.

The 11-year-old is a descendant of McCoys who harken from West Virginia and are, according to her grandmother, Goldie, kin to the notorious family known for its long-running clash with the Hatfield family. Winnter came to the Monroe Carell Jr. Children's Hospital at Vanderbilt because of a tumor that had developed on her adrenal gland.

It wasn't the first experience her family has had with Vanderbilt; her grand-aunt and guardian, Rita Reynolds, had similar tumors removed at Vanderbilt a couple of years ago and trusted the doctors here. Also, Winnter's family knew that surgeons at Children's Hospital remove such tumors with newer, minimally invasive techniques.

But here's where the young girl's story takes a fascinating turn: Winnter's family has a theory about a connection between these tumors, which run in their family, and the famous feud carried on by their forebears.

“Winnter and I both know these tumors can send your moods up and down,” Rita Reynolds said. “They diagnosed Winnter with attention deficit disorder, but I think it's the adrenal tumor that's been making her hyperactive at times.”

Winnter's doctors say that's very possible. And they say the theory that a genetic predisposition for adrenal tumors — caused by a genetic disorder called von Hippel-Lindau, which Winnter's family carries — is a possible explanation for why the McCoy half of the Hatfield and McCoy feuding family members were so violent and angry.

“What we know about adrenal tumors is they cause the release of massive amounts of catecholamines, chemicals like adrenalin,” said Wallace “Skip” Neblett, M.D., chair of the Department of Pediatric Surgery at Children's Hospital and Winnter's surgeon. “The family has this theory that the McCoys might have been temperamental because of these adrenal tumors, that it might have been related to the adrenalin surges.”

What is known about the prolonged, often-violent clash is that the two families were related to one another before it ever began. The Hatfield and McCoy feud took place in the mountain terrain of Eastern Kentucky and West Virginia. While some say it started over a pig, historians say it began with the murder of a McCoy who had served in the Union Army at the hands of Southern sympathizing Hatfields. That led to the first of many “eye for an eye” retaliations.

In 1878 “Old Randall” McCoy thought he spotted one of his pigs being stolen by Hatfields. An ensuing string of accusations, botched trials and killings took place for the next decade until the climactic burning of Old Randall McCoy's home and the murder of this son and daughter in 1888.

Before it was all over, 13 members of the families died violent deaths. Some say the feud fizzled out when a Hatfield married a McCoy, but there was no further violence after the deaths of the two leaders of the clans, Old Randall McCoy, and Devil Anse Hatfield, in 1914 and 1921 respectively.

In 2002, a symbolic peace treaty was signed by the descendants of the Hatfield and McCoy families. Members of Winnter Reynolds' family have attended the fair-like Hatfield-McCoy reunions for years and have been swapping stories about their distant cousins all their lives.

“The theory is, maybe those early McCoy's had these adrenal tumors as well and that's what helped to set them off,” said Winnter's uncle, Frank Hankins.

“They used to call it madness disease,” said Rita Reynolds. “There has been a cycle of this madness disease related to tumors since way back, and now that we've been part of the study on von Hippel-Lindau disease in Virginia.”

Rita and Frank's mother, Goldie Hankins, was born a McCoy and said her parents, “Smallwood” and Mary McCoy, are buried at a family cemetery near an historic McCoy homestead in West Virginia.

Revi Mathew, M.D., associate professor of Pediatrcs and Winnter's endocrinologist, chuckles when asked about the theory. As a recently naturalized citizen from India, he says he's only beginning to become familiar with the story that lives so vibrantly in American lore.

“From the scientific point of view, the genetic condition the McCoy family has, von Hippel-Lindau Disease, is associated with too much adrenaline and related compounds because of a condition called pheochromocytoma, a type of tumor of the adrenal gland,” Mathew said.

“It does produce hypertension, headache and sweating intermittently depending on when the surge of these compounds occurs in the bloodstream. I suppose these compounds could possibly make somebody very angry and upset for no good reason.”

But Mathew adds Winnter's condition is nothing to laugh about. On March 1, she underwent surgery to remove a tumerous adrenal gland. Because von Hippel-Lindau can cause tumors in several organs over the span of a person's life, it is possible this is just the first of many surgeries.

“This can be a difficult surgery,” said Neblett. “If the tumor is over-manipulated during surgery, the blood pressure and heart rate can get dangerously high. But with techniques we have been perfecting over the years, we thought laparoscopic removal of the tumor would work well, and she did very well.”

That means Winnter has a series of one-inch scars, a far cry from the scars Rita and other family members bear.

“It goes all the way across for me,” said Rita Reynolds. “It's a nice, thin scar, but it runs completely across from my right side to my left. It helped Winnter to know she wouldn't have a big scar, but then she knows what a long family history we have,” Rita said.

Rita is afraid for Winnter. There are stories about cousins, aunts and uncles who have endured multiple surgeries, and a few who have died from von Hippel-Lindau. The family is part of the medical literature , having been featured in the Journal of Clinical Endocrinology and Metabolism as one of the largest families ever documented to carry the von Hippel-Lindau gene. The study was written in 1998 by researchers at the University of Virginia in Charlottesville, and referred to the family as the semi-anonymous “McC family.”

Right now, Winnter is more comfortable playing video games on her computer than researching her own disease or her family's famous past — which even some family members dispute — but she is fortunate to be treated at a time when less invasive surgeries can be performed, so that she can avoid the scars and long, painful recoveries that are also a part of her family history.

Her hope is that one day her family could be better known for helping scientists learn how to treat a devastating disease than for the feud the disease might have helped trigger.