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splanchnomegalic symptom, of no etiological importance ; on the 

 contrary, it is essential that we should recognize its fundamental 

 pathogenetic significance. Now that we know that pathological 

 conditions of the hypophysis may produce widely different clinical 

 conditions, the occurrence of hypophysal tumour without sym- 

 ptoms of acromegaly, can no longer be adduced as evidence 

 against the hypophysal origin of acromegaly. So long as our 

 knowledge of the nature of the changes in the hypophysis which 

 lead to acromegaly is incomplete, these negative cases must be 

 regarded with special interest ; in so far as the pathogenesis of 

 acromegaly is concerned, however, they are irrelevant. 



The relationship between hypophysal tumour and acromegaly 

 has been variously interpreted. The original view of Pierre 

 Marie, which was adopted by a large number of authors, was 

 that acromegaly was the expression of insufficiency or suppression 

 of the hypophysal function, in the same way that myxcedema 

 expresses insufficiency on the part of the thyroid gland. This 

 theory is supported by the frequent occurrence of destructive 

 changes in the hypophysis. A further very strong piece of evi- 

 dence in favour of this view is afforded by the acute form of 

 acromegaly described by Stern berg, in which the condition, in 

 its most clearly defined clinical form, develops practically under 

 the eyes of the observer. In all these cases the post-mortem re- 

 vealed an acute progressive tumour, frequently sarcoma, of the 

 hypophysis. It w r as already known to Marie that the hypophysal 

 changes frequently consisted only in hyperplastic processes, 

 though this seems hardly consistent with the theory of a reduced 

 activity on the part of the organ. It has been pointed out upon 

 many sides, that simple glandular hyperplasia and adenoma are 

 of far more frequent occurrence than destructive tumours asso- 

 ciated with connective tissue proliferation. With regard to the 

 malignant form, Hanau and Benda found that tumours, which 

 at first sight appeared to be sarcomatous, contained cells derived 

 from the hypophysal epithelium and they described these tumours 

 as hyperplastic, malignant adenoma. Hanau suggests that the 

 same adenomatous form may have been present in other cases 

 which have been described as sarcoma. 



Certain animal experiments which seem to show that the 

 extirpation of the hypophysis does not produce pathological 

 changes in animals, were at one time regarded as important 

 evidence against the assumption of a suppression of hypophysal 

 activity in acromegaly. But to-day this argument has little 

 weight, for we know that the suppression of the hypophysis in 

 animals, as in man, is not by any means an indifferent occur- 

 rence; on the contrary, it is followed by a number of pathological 

 symptoms. The backwardness in development so clearly seen in 

 young animals after hypophysectomy may be taken as proof of 

 an influence exercised by the hypophysis upon the growth of 



