33 2 INTERNAL SECRETION 



Of the other clinical symptoms, glycosuria is the most im- 

 portant and is of comparatively frequent occurrence. The fre- 

 quency of acromegalic diabetes, as reported up to now, is 10 to 

 35.5 per cent, and over. The intensity and the course of the 

 glycosuria are subject to considerable variation. 



The other metabolic changes observed in acromegaly are not 

 typical. In some instances the total metabolism has been found 

 to be increased (Magnus-Levy), in others it has been found 

 to be unaltered (Salomon). Several authors found retention of 

 nitrogen, and they associated this with the abnormal growth of 

 the tissues. With regard to the metabolism of salt, several 

 authors (Moraczewski, Edsal and Miiller, Parhon) found reten- 

 tion of P, Ca, and Cl. Franchini found retention of N, CaO 

 and MgO, accompanied by excretion of P and Cl. It is very 

 difficult to estimate the metabolic changes in acromegaly, owing 

 to the fact that the condition is frequently associated with myx- 

 oedematous symptoms (Pineles). On the other hand, Magnus- 

 Levy points out that the metabolic changes of acromegaly possess 

 certain analogies with those of Graves's disease; such, for in- 

 stance, are the excessive perspiration, so frequently observed; the 

 increased combustion, proved in a certain number of cases; and 

 slight or severe glycosuria. 



The course of the disease is usually chronic and extends over 

 a period of years. Cases are occasionally met with, however, 

 where, owing to the rapid growth of the hypophysal tumour, the 

 fatal termination takes place sooner and is accompanied by the 

 general symptoms of intercranial pressure. In many instances 

 the patients die as the result of intercurrent affections. In the 

 typical course of the disease, progressive emaciation and cachexia 

 make their appearance at the end of a term of years and lead, 

 ultimately, to death. 



Of the pathologico-anatomical findings in acromegaly, the 

 most important are the changes in the hypophysis itself, first 

 described by Marie and Marinesco. Before considering the 

 pathogenetic significance of these changes, it is expedient first 

 to describe the post-mortem findings in the other organs and 

 tissues. The increased volume of the soft parts is brought about 

 by thickening of the epidermis, hypertrophy and enlargement of 

 the papilla? of the skin, and pronounced infiltration of the sub- 

 cutis, with proliferation of the subcutical connective tissue. The 

 connective tissue proliferation extends also to the deep-lying soft 

 parts and to the interstices of the muscle fibres ; the latter show 

 enlargement and proliferation of the nuclei and, later on, de- 

 generative changes. The hypertrophy of the mucosa, especially 

 noticeable in the case of the tongue, is caused by hyperplasia of 

 the mucous membranes, proliferation of the papilla?, and multi- 

 plication of the connective tissue. Occasionally the visceral 

 organs are also enlarged. A hyperplastic thymus is by no means 



