ACROMEGALY 253 



think very plausibly of an existing predisposition; we might also be inclined 

 to believe that repetition of the pregnancy would lead to permanent manifes- 

 tation of the disease. 



Goiters and alterations in the function of the thyroid occur in acromegaly with 

 great frequence. The development of the goiter may occur about simulta- 

 neously with that of acromegaly, and thus symptoms of hyperthyrosis or hypo- 

 thyrosis may become manifest simultaneously with acromegalic symptoms. 

 Manifestations of a slight hyperthyrosis in acromegaly are especially common. 

 Magnus-Levy and Salamon have especially directed attention to this subject. 

 Later, in the consideration of the manifestations on the part of the vegetative 

 nervous system, we shall see that among the more frequent symptoms in 

 acromegaly are sweats. We shall have to consider, however, whether we are 

 justified in regarding them as a symp torn of a simultaneous hyperf unction, and 

 whether they do not signify rather that certain organs of supply of the vegeta- 

 tive nervous system are not directly influenced by the irritation of these 

 nerves, on account of the hyperfunction of the hypophysis. A tachycardia 

 might be regarded as a surer symptom of hyperthyrosis especially when there 

 exists thyroid swelling and increased fall in blood-pressure. 



In case U (Observation XXIV) the thyroid was enlarged. There existed 

 profuse sweats and a slight grade of tachycardia. Slight enlargement of the 

 thyroid was present also in case T, Observation XXV, but in this case symp- 

 toms of hyperthyrosis were not distinct. 



Of the remaining symptoms, of Basedow's the following have been stated 

 to have occurred in the course of acromegaly: tremor, transitory rises of 

 temperature, cardiac palpitation, increased psychical irritability. 



The following is a very instructive example of the simultaneous develop- 

 ment of acromegaly and a slight hyperthyrosis. 



Observation XXX. M. St., thirty-seven years old. First admission at hospital in De- 

 cember, 1896. Menses appeared first at the eighteenth year, and were regular up to the 

 twenty-fourth year of life. From then on they remained absent. At the thirty-first year 

 tearing pains in all the members appeared, especially at night. The fingers were swollen, 

 and there were sometimes intense sensations of heat. Since that time there have existed 

 severe headaches. Finally there developed about this time a goiter. In addition there 

 appeared pains in the neighborhood of the thyroid gland, which recurred every month. Lately 

 forgetfulness, lassitude, and weakness. The motor power has weakened. 



Typical acromegaly and thickening of the nose, hands and feet. Circumference of the 

 throat 44 cm. Slight degree of anemia. (Hemoglobin 65 per cent., erythrocytes 4,000,- 

 ooo.) Enormous struma of the thyroid, both lobes diffusely enlarged, with circumscribed 

 nodules, no hemianopsia, no disturbances of vision. Slight kyphosis. 



Second admission, March, 1892. Now marked kyphoscoliosis. The acromegaly has 

 advanced. 



Third admission, August, 1899. 



Fourth admission, December, 1899. Fine tremor, exophthalmus, tachycardia, marked 

 alimentary glycosuria 2.25 per cent, dextrose in urine when 100 gm. dextrose administered. 



To 100 gm. levulose, Trommer at times distinctly oositive. 



