HYPOPHYSIS CEREBRI 341 



in the genital organs in acromegaly do not appear until the con- 

 dition is far advanced. 



In the present incomplete state of our knowledge, it is not 

 possible to define with certainty the primary origin of the hypo- 

 physal changes which give rise to the symptoms of acromegaly. 

 It may be that the condition is not the outcome of a single, 

 definitive cause. Hypertrophy of the hypophysis may take place 

 primarily as the result of adenoma formation, which is extremely 

 frequent in that organ; or it may be a secondary condition, the 

 result of the primary affection of other internal secretory organs 

 and of the sexual glands more particularly. From the known 

 interrelationship between the hypophysis and the sexual glands, 

 as well as from the fact that atrophy of the sexual glands is 

 invariable at some stage of acromegaly, it seems highly probable 

 that suppression of the function of the sexual glands plays a part, 

 first in the causation of the clinical complex of acromegaly, and, 

 afterwards, in the furtherance of the processes of growth by which 

 the disease is characterized. Knowing, as we do, the manifold 

 interactivities which subsist between the various internal secretory 

 organs, it is not difficult to see that other internal secretory organs 

 besides the hypophysis may be concerned in the production of 

 acromegaly, in the same way that Graves's disease is attributable 

 to the influence of organs other than the thyroid. Regarded from 

 this point of view, acromegaly belongs to the group of the poly- 

 glandular diseases. 



A second pathological condition which is associated with the 

 hypophysis is gigantism (gigantismus, macrosomia). The classi- 

 fication of gigantism as a pathological condition is justified by 

 the facts : first, that abnormal longitudinal development of the 

 bones and increase in the volume of the organs must be regarded 

 as a perversion of the processes of growth ; and second, that 

 abnormality of growth rarely occurs singly, but is almost invari- 

 ably associated with derangements of the function, and of the 

 anatomical constitution, of different organs. It is only the giants 

 of fairy tales who, in addition to their size, are favoured with 

 exceptional physical and mental advantages. A closer acquaint- 

 ance with the giants of our day, as well as a careful analysis of 

 the descriptions which have come down to us of the giants of old, 

 shows that normal giants that is to say, persons of exceptional 

 size and free from deformity or other pathological signs, such as 

 were assumed by Langer, and later by Sternberg are very rarely 

 encountered. The vast majority of giants are undoubtedly abnor- 

 mal and belong to the class of pathological individuals. 



Launois and Roy, who have made a special study of this 

 phase of abnormality, define the condition as follows : Gigantism 

 is an anomaly of skeletal growth which leads to a height of the 

 body in excess of the average dimension of the race, and is 

 associated with characteristic morphological and functional de- 

 rangement. 



