ACROMEGALY 235 



the fact that the posterior lobe may be removed without the anterior lobe's 

 losing its function (Crowe, Gushing and Romans] , and finally the observation 

 of v. Cyan that in hypophyses of cattle and sheep the anterior and posterior 

 lobes may be separated from each other by small plates of bone. It may well 

 be supposed that, as is true for the external secretion of the thyroid, the exit 

 channel for the internal secretion of the anterior lobe is formed by the lymph- 

 vessels or the blood-vessels. 



The secretion of the posterior lobe would seem to pour out into the third 

 ventricle through the recessus infundibuli. Gushing and Gotsch in animal 

 experiments found that the cerebrospinal fluid increases the blood-pressure 

 in a manner analogous to the action of infundibular extract. I would like 

 to see demonstrated the fact that the cerebrospinal fluid acts as a diuretic as 

 does pituitrinum infundibulare. 



a. Acromegaly 

 Hyperpituitarism, Marie's Disease 



Definition. By acromegaly we understand a disease that is characterized by 

 the gradual enlargement of the peaked [gipfelnde, i.e., peaked, acral] parts (nose, 

 lips, tongue, lower jaw, hands and feet) and by hyper plastic alterations in the 

 entire osseous system. . There mostly develops an appreciable enlargement of the 

 hypophysis, which leads to broadening of the sella turcica. Associated with this 

 is localization of corresponding symptoms of brain pressure. To this are 

 added very frequently alterations of the thyroid gland of a hyper plastic character, 

 marked accentuation of the function of the interstitial glands; also, very frequently, 

 loss of function of the genital glands after preliminary transitory increase of 

 function, and, apparently frequently, hyperplasia of the suprarenal cortex. 

 Also the condition of excitability of the vegetative nerves is sometimes increased 

 in manifold ways. Very frequently there occurs rapid withering away of the 

 body and manifestations of degeneration of manifold nature. The pathological 

 anatomical finding in the hypophysis is an adenoma or adenocarcinoma of 

 the anterior lobe. To-day we refer acromegaly to an increase of function of the 

 glandular hypophysis. 



Occurrence. Acromegaly is not a very rare disease. It does not seem to 

 give preference to any country or to any race of people. It usually begins 

 between the ages of twenty and forty years, most frequently between 

 the twentieth and thirtieth year of life (Sternburg). According to this author 

 it usually occurs in women later than in men. There are also rare cases 

 of acromegaly that begin in the years of childhood or adolescence. These 

 are of special importance. I shall refer to them in greater detail in the 

 consideration of the pathogenesis. Hereditary or familial occurrence 

 seems to be very rare. I have found very few statements as to this ques- 

 tion in the literature and all these are very indefinite. Thus Arnold in 



