252 THE DISEASES OF THE HYPOPHYSIS 



As far as I have been able to find, a similar case of conception in acro- 

 megaly has been reported only by Pirie. 



However, in the great majority of cases of acromegaly, as has already 

 been mentioned, there occur sooner or later signs of extinction of tlje function 

 of the generative glands. This may occur even early, constituting a differ- 

 ential diagnostic difficulty. In man there soon comes to pass lessening or 

 complete loss of potency and libido, and in woman amenorrhea. As the latter 

 is attended with a cessation of ovulation, it may very well be supposed that as 

 yet no case of conception has been observed in an amenorrheic acromegalic 

 woman. 



In such cases the sexual glands and the internal generative organs gradu- 

 ally atrophy. Tandler and Grosz found total retrogression of the primordial 

 follicles and cessation of the formation of Graafian follicles, and in man 

 alteration of the epithelium of the seminal tubules and, finally, also alteration 

 of the interstitial cells. On gynecological examination the uterus is usually 

 found to be small. Not rarely cystic degeneration of the ovaries is also 

 present. Atrophy of the internal genitalia was found in 36.4 per cent, of 

 118 cases, according to the statistics of Creutzfeldl. 



That even on long-continued amenorrhea the follicular apparatus may not 

 degenerate entirely is shown by a case of Cagnetto; menstruation ceased at the 

 age of nineteen years; at the age of forty-six years it reappeared and continued 

 to the age of forty-eight years, when it disappeared for good ; autopsy showed 

 cystic degeneration of the tumor of the pituitary; in this case it is not unlikely 

 that the hyperfunction was restricted by the cystic degeneration. 



We may therefore briefly sketch the relation between hypophysis and 

 sexual glands, thus: increased activity of the hypophysis stimulates the ac- 

 tivity of the interstitial glands (apparently also the suprarenal cortex). 

 The glands of generation are sometimes also stimulated to increased activity 

 at first, but more often the activity is suspended. Conversely we find that 

 on increased activity of the sexual glands there is also increased activity 

 of the hypophysis. I believe, in opposition to the prevailing teaching, that 

 there is in pregnancy an increased activity of the sexual glands, as I regard 

 the developing fetus as a prolonged ovulation (see chapter on the sexual 

 glands) there is found enlargement of the hypophysis and signs of an in- 

 creased function of that organ, coarsening of the facial features, etc. (Tandler 

 and Grosz). Indeed a transitory acromegaly may even occur during this 

 period. Such a case is reported by R. Marek. Pronounced acromegalic 

 symptoms occurred during pregnancy in a twenty-seven-year-old primipara. 

 Nose, tongue, and jaws became larger, the teeth spread apart, the hands and 

 tongue increased in circumference, the tonsils swelled, glycosuria, lassitude, 

 sleeplessness and insomnia, and also drawing pains in the muscles made 

 their appearance. All signs disappeared during the puerperium. 



In such cases of formes frustes of acromegaly during pregnancy, we may 



