342 INTERNAL SECRETION 



Gigantism attacks men more frequently than women, and 

 usually takes its rise at the period of puberty. Thus at the age 

 of 1 8 to 20, the height of the subject may be 190 to 200 cm., or 

 more ; and at 25 to 30, when the normal individual has long ceased 

 to grow, it may be still increasing. 



The parts principally affected are the extremities, especially 

 the lower ones, while the trunk is only slightly influenced, and 

 the skull appears small in comparison with the rest of the body. 

 The excessive length of the lower part of the body, as compared 

 with that of the upper part, is characteristic of typical gigantism. 

 Separation of the epiphysal synarthroses, and hypertrophy of the 

 osseous substance of the long bones, may be seen in vivo by means 

 of skiagrams. Subsequent anatomical investigation confirms 

 these findings, and shows the persistence of the cartilage at the 

 junction between the epiphysis and diaphysis, as well as the 

 imperfect ossification of the sutures and various signs of hyper- 

 ostosis. The vertebral column frequently shows postero-lateral 

 curvature (kyphoskoliosis). The most remarkable point about 

 gigantism, however, is that, in the majority of cases, the skeleton 

 of the face and of the acral portions shows changes which are 

 distinctly characteristic of acromegaly. Exaggeration of the 

 zygomatic arches, marked projection of the supraciliary arches, 

 prognathism of the lower jaw, thickening of the bones of the skull, 

 enlargement of the antrum and sinuses, and deepening of the 

 sella turcica, are the usual facial characteristics of the gigantic 

 subject. With these, changes of the hands and feet, entirely 

 analogous to those of acromegaly, are frequently associated. 



Of the internal findings, the most interesting is undoubtedly 

 the condition of the hypophysis. The deepening of the sella 

 turcica points to an enlargement of the organ, and this was 

 established by Launois and Roy, who found that, in ten cases of 

 gigantism which they examined post mortem, there was more or 

 less marked increase in the size of the hypophysis. In the 

 majority of cases there was hyperplasia of the glandular tissue and 

 adenoma formation ; more rarely there was vascular struma ; and 

 in a few cases there was sarcoma and epithelioma. 



In the majority of cases of gigantism, the weight of the brain 

 is remarkably small in proportion to that of the body. The 

 reports of the condition of the thyroid glands are not unanimous. 

 In the greater number of cases, the thyroid was much 

 enlarged, the weight varying from two to six times the normal. 

 In one case, Wells showed that the iodine contents, though rela- 

 tively normal, were absolutely very much increased. On the 

 other hand, there are descriptions of cases of gigantism in which 

 the thyroid was normal or even comparatively small. Persistence 

 of the thymus has not been described. 



The most remarkable changes in gigantism are those pre- 

 sented by the sexual glands. Reduction of sexual activity, 



