198 THE PITUITARY, THYROID AND ADRENALS AS A SYSTEM. 



That the suprarenal glands should be credited with the 

 great majority of the symptoms now ascribed to the pituitary 

 alone is evident. Indeed, the remaining signs that might be 

 attributed to the latter may be still further limited in number. 

 Among those to be excluded are the various phenomena due 

 to pressure of the enlarged pituitary. The headache is one of 

 these, although its severity is probably increased during the 

 first stage by the cerebral hyperaemia caused by overactivity 

 of the adrenals. The many symptoms of which the visual 

 apparatus is the source, excepting those due to the loss of 

 local muscular power already referred to, are also ascribable 

 to pressure of the hypertrophied pituitary. The senses of 

 smell, taste, and hearing are occasionally involved. 



Mental phenomena are frequently observed, but, as a rule, 

 they are credited to the mortification suffered by the patient 

 because of the deformities of features and form which the dis- 

 ease brings on. They appear to us to merit a far more con- 

 spicuous position in the pathology of acromegaly than they are 

 given, owing mainly to the light their close connection with 

 so manifestly a trophic disorder may shed upon the mental 

 diseases in general. Do they belong to the domain of the 

 pituitary or to that of the adrenals? We have seen that mania 

 is associated with suprarenal overactivity while melancholia is 

 observed during the stage of insufficiency. 



In referring to Blair's case of persecutory mania asso- 

 ciated with acromegaly, 25 and to his remark that but three 

 cases had come to his knowledge, one in England and two on 

 the Continent, R. H. Hutchings 28 likewise emphasizes the fact 

 that sufficient attention has not been given the mental symp- 

 toms of the latter disease. He also reports two instances, one 

 of which, a typical case, is particularly interesting to us, since 

 death occurred before the second or cachectic stage had 

 been reached. Unfortunately the pathological histology of the 

 brain is not given, but the statement that it "was compact, 

 of good weight and firm," while no reference is made to pe- 

 ripheral pressure lesions in the neighborhood of the enlarged 



28 Blair: Journal of Mental Science, April, 1899. 



M R. H. Hutchings: Archives of Neurology and Psychopathology, vol. i, No. 

 4, 1898. 



