200 THE PITUITARY, THYROID AND ADRENALS AS A SYSTEM. 



of acromegaly appeared. He then began to grow rapidly, and 

 in one year had nearly reached his present size, 6 feet, 3 

 inches. At sixteen years and ten months he weighed 210 

 pounds. Yet a Rontgen-ray examination showed "a uniform 

 hypertrophy, merely an exaggeration of the normal state." 

 Here, again, we find evidence of suprarenal overactivity, though 

 none of the pressure symptoms headache, etc. are as yet 

 present. The arterial tension is increased, the hyperidrosis of 

 peripheral vascular pressure is present, the apex-beat is forcible, 

 and there is increasing polyuria March 10th, for instance, 

 2400 cubic centimeters daily, and October 15th, 6810 cubic 

 centimeters daily. That the vision is becoming impaired is 

 also suggested by an examination of the eyes by Dr. Thoring- 

 ton, who found double optic atrophy and other signs pointing 

 unmistakably, with the general symptoms, to a growth of the 

 pituitary. The predominating sign in this case, however, is 

 marked dullness over the upper portion of the sternum, indicative, 

 as shown by Erb, of an enlarged thymus. 



These few illustrations will suffice to emphasize two ruling 

 factors in the study of this question: (1) that the adrenals and 

 the pituitary are interdependent, and (2) that acromegaly may 

 be the result of more than one pathogenic factor. In Hutch- 

 ings's second case, for instance, there is every reason to believe 

 that an already inadequate, and therefore vulnerable, pitui- 

 tary, as shown by the patient's mental torpor, traced back to 

 his childhood, underwent morbid development under the in- 

 fluence of the adrenal overactivity to which the accesses of epi- 

 lepsy point. The normal dense vascular supply of the pituitary 

 readily shows that such a process is possible if its physiological 

 resistance is below the normal standard. Unduly stimulated 

 itself by overoxidized blood, it may thus have been able to over- 

 nourish the various structures under its functional influence. 

 The various tissues bone, muscles, etc. involved in such 

 cases are developed to an abnormal degree, the whole process 

 being further sustained indirectly by the suprarenal over- 

 activity, which affords a corresponding and necessary increase 

 of oxygen to insure nutritional metabolism. We thus have a 

 form of acromegaly directly due to suprarenal overstimulation 

 of the pituitary, in which, as in Hutchings's case, a structurally 



