204 THE PITUITARY, THYROID AND ADRENALS AS A SYSTEM. 



of another vicious circle in which the organs enhanced each 

 other's activities. 



Resuming the consideration of the mental phenomena 

 observed in practically all cases of acromegaly hardly percep- 

 tible in some and very marked in others to the query as to 

 whether they can be ascribed to the adrenals or the pituitary, 

 the only answer possible so far is the following: The above 

 evidence tends to show that intense suprarenal overactivity can 

 so engorge the cerebral capillaries as to cause a disruptive 

 hemorrhage in an enlarged pituitary body. Whether the men- 

 tal symptoms are ascribable to the cerebral hyperaemia or to 

 the impairment of certain functions of the pituitary itself or 

 to both it is as yet impossible to say. We can only recognize, 

 for the time being, that, with the stage of acromegaly in which 

 the adrenals are overactive, the mental aberration is of a kind 

 usually associated with cerebral hyperaemia and which may in 

 some cases of acromegaly assume considerable violence. Thus, 

 in Tamburini's case 36 some years after the onset of the acro- 

 megalic symptoms the patient, a young woman, manifested 

 delusions of persecution with violent excitement, terminating 

 in dementia. In another instance, reported by H. W. Coe, 37 

 the patient, a woman aged 50 years, finally assumed such 

 homicidal proclivities that she was committed to an asylum. 

 In Tamburini's case a very large pituitary was found, an 

 adenoma; Coe's case was still living and in the asylum at the 

 time of the report. We may perhaps acquire more light in this 

 connection through the next feature to be analyzed: i.e., the 

 relationship between the thymus and acromegaly. 



We have seen that in Shallcross's case of acromegaly in 

 an adolescent imbecile there was marked dullness over the 

 upper portion of the sternum. Klebs 38 and Erb 39 have em- 

 phasized the importance of the persistence of the thymus in 

 acromegalic subjects, and "Erb's sign," dullness on percussion 

 over the upper third of the sternum, was once deemed an im- 

 portant diagnostic feature of the disease. It gradually lost 



89 Tamburini: Loc. cit. 



87 H. W. Coe: Journal of the American Medical Association, Dec. 3, 



88 Klebs: Allgem. Pathol., vol. ii, 1889. 



89 Erb: MUnchener med. Wochenschrift, No. 24, 1894. 



