THE PATIIOGENESIS OF ACROMEGALY. 201 



weak organ first undergoes the causative hypertrophy, then 

 finally yields by retrograde metamorphosis to the undue and 

 continuous labor imposed upon it. But during all its period 

 of overgrowth and overactivity the pituitary had in turn stim- 

 ulated the adrenals, thus establishing a vicious circle, with 

 overwork of both organs as result. 



That this conception of the pathogenesis of the disease 

 is based on solid foundation is shown by the experimental use 

 of pituitary extract by Mairet and Bosc 29 in twenty-one epi- 

 leptics, administered by the mouth or by subcutaneous injec- 

 tion. The number of seizures was not only increased, but a 

 state of mental exaltation appeared which, in some of the cases, 

 was totally different from any mental aberration that they had 

 previously shown. 



As to the second stage, here, as elsewhere, the pituitary 

 merely yields to the overwork imposed upon it. undergoes 

 deterioration, not a mere return to normal conditions, but 

 either softens, as in the case recorded by Eoxburgh and Collis, 

 or undergoes the far more common process of fibrous indura- 

 tion. The suprarenal glands then not only fail to receive the 

 additional stimulation resulting from the overactivity of the 

 pituitary, but they lose the normal support which the latter 

 had afforded them. Thus seems to be inaugurated not only 

 the stage of suprarenal insufficiency, but also the cachectic 

 stage of the acromegalic syndrome itself. 



If all this is true, we should have evidence of suprarenal 

 insufficiency, as manifested through its cardinal expression, 

 myxcedema, along with those of insufficiency of the pituitary, 

 since reduced functional activity of the adrenals should corre- 

 spondingly impair the nutrition of both the other organs. 

 That simultaneous and sufficiently advanced inadequacy of all 

 three sets of organs gives rise to but one result i.e., myx- 

 cedema is well shown by two cases in which necropsies were 

 performed by Ponfick 30 and quoted here purposely from an 

 abstract to show the solidity of the position taken: "One 

 patient died early in the course of the disease from inter- 



28 Mairet and Bosc: Archives de Physiologic norm, et path., July, 1896. 

 30 Ponfick: British Medical Journal, June 16, 1900, from Zeitschrift fiir klin. 

 Medicin, Bd. xxxviii, H. 1. 



