196 THE PITUITARY, THYROID AND ADRENALS AS A SYSTEM. 



always dealing with acromegaly, and this fact, coupled with 

 the probability emphasized by the above data that there is 

 always overactivity of the pituitary when either of these two 

 conditions is present, may help us to ascertain the nature of 

 the symptoms of pituitary origin. 



Whether they appear in the adolescent or in the adult, the 

 earlier symptoms of acromegaly are always insidious. Enlarge- 

 ment of hands, feet, or head may constitute the first indications 

 of disease and be perceived only through the unmistakable 

 tightness which the shoes, gloves, or headgear may assume. 

 There may be some headache, rheumatic pains, or impairment 

 of vision, and the disease may be considerably advanced before 

 it is recognized as such. In a case reported by Leszynsky, 22 

 for example, the patient had frequently been the object of 

 jocular remarks concerning the size of his feet and hands 

 before he suspected disease, and visited the hospital because 

 of his vision, which had become "blurred" a year before. In 

 another case reported by Johnston and Monro 23 acromegaly 

 followed parturition. A swelling around the eyes was the first 

 sign, and never disappeared. Shortly afterward enlargement 

 of the face, hands, and feet became apparent. About two and 

 one-half years later her vision began to fail, and it was about 

 this time that she first complained of headache, which, from 

 being paroxysmal, soon became constant. We have in these 

 two instances, among the many that have been reported, clearly 

 defined symptoms of hyperplasia of the pituitary. If now ex- 

 cessive activity of the latter enhances suprarenal activity and 

 correspondingly increases oxidation, we should, even among 

 these earlier manifestations, find evidence of this excessive 

 oxidation. 



While the suprarenal phenomena of the earlier stage are 

 not always referred to in all accounts of cases, they are given 

 in many, and their enumeration will suffice to at once recall 

 their relative frequency: i.e., excessive and sometimes ravenous 

 appetite, thirst, polyuria, a full and hard pulse, and, often, cuta- 

 neous hypercesthesia, a sensation of abnormal superficial heat, and, 

 after the case has progressed some time, muscular hypernutri- 



22 Leszynsky: Medical Record, March 4, 1899. 



88 Johnston and Monro: Glasgow Medical Journal, August, 1898. 



