ACROMEGALY 



241 



yet retrogressed. Several times at the beginning the patient showed a rise in temperature, 

 but at present the temperature is normal. Headaches at times. Examination of the 

 purin metabolism shows just as decided an increase of the endogenous elimination of uric 

 acid as before the operation. 



i 

 In many cases the muscle 



strength is not diminished in the 

 initial stages. Sometimes such in- 

 dividuals show even an extraordi- 

 nary strength. There is, however, 

 from the beginning a gradually in- 

 creasing and rapid fatigability, and 

 in the later stages such individuals 

 cannot long follow their occupation 

 on account of muscular weakness. 

 Microscopically such muscles show 

 increase of the connective tissue 

 and degeneration and atrophy of 

 the muscle fibers. Arnold de- 

 scribes vacuolization, multiplica- 

 tion of the nuclei, and atrophy of 

 the muscle fibers, increase in the 

 number of nuclei, and growth of 

 interstitial connective tissue, also 

 the occurrence of fat cells in- the 

 connective tissues. 



Also in the skin are found, es- 

 pecially in the sacral parts, sclerotic 

 processes affecting both the epider- 

 mis and cutis. The papillae are 

 enlarged, and the sclerosis ex- 

 tends to the nerves and vessels 

 and to the connective tissue fasci- 

 culae surrounding the glands. Fre- 

 quently abnormal pigmentations 

 are found. In spite of sclerosing 

 processes the skin may be readily 

 raised up in folds, which fact is 

 important in the differential diag- 

 nosis from myxedema. In the 

 later stages true myxedematous 

 alterations of the skin are found not rarely (see below) . 



Pierre Marie found mollusca pendula in numerous cases 



FIG. 36. Abnormally strong growth of hair in 

 acromegaly (Observation XXV). 



The secretion of 



16 



