192 THE PITUITARY, THYROID AND ADRENALS AS A SYSTEM. 



their saline decoctions, which produced depressor effects, must 

 have been potent agents. This observation, linked with the 

 fact that cerebral gray matter produced similar effects, is valu- 

 able and suggestive, and will serve as the starting-point in our 

 search for the active principle of the organ referred to. For 

 the time being, we can safely, however, forimilate the proposi- 

 tion that the pituitary gland stimulates the secretory functions of 

 the adrenals and thereby enhances the activity of the oxidation 

 processes. 



THE PATHOGENESIS OF ACROMEGALY. 



What is the nature of the specific symptoms, independent 

 of those ascribable to the adrenals, to which morbid changes 

 of the pituitary can give rise? We have in exophthalmic goiter 

 the type of a disease brought on indirectly through functional 

 overactivity of the thyroid and adrenals. May we not have in 

 acromegaly a disease also brought on through excessive func- 

 tional activity of the pituitary and the adrenals? 



There seems to be good ground for a separation of the 

 morbid phenomena generally ascribed to the pituitary into 

 two distinct, though related, syndromes. Thus, Marinesco, 14 

 after examining four cases of acromegaly by means of the 

 Eontgen rays, reached the conclusion that, if this disease 

 comes on in adult life, the osseous hypertrophy is of a massive 

 type, while, when it affects adolescents, the bones increase in 

 length as well as in volume. The latter represents the "giant" 

 type of acromegaly. Again, Brissaud and Meige, 15 in a study 

 of the statistics of gigantism, including two personal cases, 

 found that this condition often precedes acromegaly, although 

 both are traceable to the same anatomical process. Gigantism 

 can, however, remain such and not be followed with acro- 

 megaly; the latter, on the other hand, can appear alone, since 

 it is by no means always attended with gigantism. The giant 

 type appears during the process of normal growth, while acro- 

 megaly can appear subsequent to this process. M. Sternberg 16 

 goes even so far as to state, that gigantism is not a disease 



14 Marinesco: Gazette Hebdomadaire de M6decine, June 18, 1896. 



18 Brissaud and Meige: Nouvelle Iconographie de la Salpgtriere, No. 6, 1897. 



18 M. Sternberg: Zeitschrift fur klin. Medicine, vol. xxvii, 1895. 



