108 



phalanges (fig. 76). 



The Endocrine Organs 



FIG. 75. Typical hand of acrome- 

 galic. (Gushing.) Notice the 

 broad palm and digits and the 

 relatively small nails, which lack 

 lunulee. 



But the enlargement is not confined to the bones of 

 the extremities ; it affects the whole skeleton, 

 which becomes thickened and hypertrophied. 

 There is often considerable muscular develop- 

 ment ; the subject being abnormally strong. 

 If the affection does not supervene until adult 

 life is attained, i.e. until the epiphysial carti- 

 lages are ossified, the long bones do not grow 

 in length and the height is but little affected, 

 any increase of stature that is produced by 

 increase of the vertebral column being usually 

 more than compensated for by a kyphosis 

 (fig. 73), which supervenes after the disease 

 has made some progress. But if the hyper- 

 pituitarism commences whilst the cartilages 

 are still unossified, there is a considerable 

 growth in length of the long bones, so that 

 the patient attains an unusual height. This 



condition is known as pituita/ry gigantism 1 (fig. 77) ; it is of essentially the 



same nature and origin as acromegaly (Tam- 



burini, Woods-Hutchinson, Lannois and Roy). 

 In acromegaly there is always enlargement 



of the pituitary. This increase in bulk often 



takes the form of a considerable tumour, which 



can usually be detected during life in skiagrams 



of the skull, the sella turcica showing a well- 

 marked enlargement. The tumour is usually 



found to affect mainly or entirely the anterior 



lobe, and if large is, as already mentioned, 



liable to affect vision and to produce headache 



and other symptoms of intracranial pressure. 

 In addition to the skeletal changes, others 



occur. The integument becomes thickened ; 



there is increased activity of the skin glands 



and a tendency to an abnormal increase in the 



growth of the hair over the body (hypertri- 



chosis). Diminution of sexual activity often 



supervenes early in the disease, although it 



may be preceded by the opposite condition. 



There is often glycosuria or simple polyuria : 2 



when present these conditions are probably associated w T ith hypertrophy of 



1 There is another kind of gigantism, without pituitary enlargement, but associated 

 with defective sexual development and analogous to the increase of stature which occurs 

 as the result of castration before puberty (see Byrom Bramwell, Clinical Studies IV., Edin. 

 Med. Journ., June 1915). 



2 Byrom Bramwell, Intracranial Tumours, 1888, and op. cit., 1915. 



FIG. 76. X-ray photograph of 

 two digits of an acromegalic 

 patient (Gushing) showing 

 the peculiar mushrooming of 

 the ungual phalanx. 



