CHAPTEE V. 



THE ANTERIOR PITUITARY BODY, THE THYROID GLAND, AND 

 THE ADRENALS AS PARTS OF AN AUTONOMOUS SYSTEM. 



IN his valuable essay on "Acromegaly" Guy Hinsdale 1 

 refers to Gauthier's 2 view, that the symptoms of this disease 

 could be divided into two stages, as follows: "Two stages in 

 the course of acromegaly have been differentiated, viz.: the 

 erethic stage and the cachectic stage. The phenomena of 

 erethism 3 which characterize the first stage embraces, first, a 

 painful hyperaesthesia, which manifests itself in headaches and 

 rheumatic pains; second, an hypertrophy of the muscular 

 fibers, which may give to patients a muscular power greater 

 than usual; third, palpitation of the heart accompanying the 

 hypertrophy of that organ; and, finally, the polyphagia and 

 polyuria, which may be considered to be connected with an 

 erethic state of the respective organs. The second stage is 

 characterized by a cachexia or a period of decadence. The 

 stage of increase has abated and the phenomena of erethism 

 have disappeared. Muscular atrophy and cardiac dilation and 

 a consequent enfeeblement of the circulation render the pa- 

 tient quite helpless. It is in this stage that bleeding from 

 the nose may ensue, and progressive debility marks the period 

 of decline, which ends in syncope. Epistaxis may also occur 

 early." 



It is perhaps unnecessary to point out that all these 

 symptoms recall those of exophthalmic goiter, barring certain 

 characteristics of the latter disease. We have seen, however, 

 that exophthalmic goiter was, in reality, the direct result of 

 suprarenal overactivity, though initiated through thyroid over- 

 activity. The foregoing acromegalic symptoms, therefore, must 



1 Guy Hinsdale: "Acromegaly"; Boyleston Prize Essay of Harvard Uni- 

 versity, 1898. 



a Gauthier: Progres Medical, May 24, 1890, and Jan. 1, 1892. 

 All italics are our own. 



(186) 



