248 THE DISEASES OF THE HYPOPHYSIS 



Very noteworthy in acromegaly are alterations in the genitalia, that is, 

 the manifestations that may be ascribed to functional alterations of the sexual 

 glands. We shall see later that for the comprehension of especially the 

 genital disturbances in acromegaly and for the pathogenesis and theory of 

 acromegaly in general there seems 'necessary a sharp distinction between the 

 function of the interstitial glands and the generative glands, at least so far as 

 this is possible, according to our present-day knowledge. As will be seen 

 from the description of the alteration in the hairiness, there is almost never 

 found in acromegaly a retrenchment of the so-called secondary sexual 

 characters and a retrogression of the external genitalia. An exception to 

 this is perhaps certain cases of acromegaly in childhood, which I shall speak 

 of in detail later. In acromegaly of adults, on the contrary, there is mostly 

 sharp accentuation of the secondary sexual characters. As has been men- 

 tioned there is often seen a strikingly strong development of the hairs of the 

 beard; the axillary hairs, the hairs on the genitalia and on the perineum grow 

 more strongly, and often there develops a marked hairiness along the linea 

 alba; the hairiness in women, as v. Noorden mentions, often assumes in this 

 case a virile type. Moreover the external genitalia often show a distinct 

 hyperplasia. The penis, the labia majora and the clitoris may appreciably 

 increase in dimensions. 



These phenomena persist until the end of the disease. In certain cases 

 we can at least say that a distinct retrogression does not occur. 



The function of the glands of generation behaves otherwise. Here we 

 mostly find premature lessening or loss of function. There are, however, 

 numerous exceptions, that I shall speak of first. At the beginning of the dis- 

 ease there is found not at all rarely signs of the increased function. Thus 

 there was for instance at the beginning, in the case of Buday and Janczo 

 (acromegalic gigantism) increased potency. 



In women, too, libido may be increased at the beginning; I here allude to 

 Observation XXVII. In this case the illness had lasted seven years; in spite 

 of this menstruation, although irregular, persisted; the libido at first in- 

 creased, later decreased. Colostrum could be expressed from the breasts. 

 Cases of persistent galactorrhea have been described byGajkievicz and Fazio. 

 In other cases the function of the glands of generation last until in the fully 

 developed disease. I refer to Observation XXV. . In this case the disease 

 began in 1903, in the year 1907 the potency and libido were entirely normal, 

 1911 the libido was as yet entirely retained, but the potency had to a certain 

 extent diminished. 



In such cases signs of increased activity of the sexual glands may be found 

 at autopsy. Thus Schultze and Fischer state that in a man aged fifty-six 

 (Case 2) in whom the acromegaly had lasted seven years, strikingly abun- 

 dant spermatogenesis was to be found in the testicles, and the prostate was 

 enlarged and in a condition of abundant secretion. 



