258 



THE DISEASES OF THE HYPOPHYSIS 



Fourth entrance to the clinic, April, 1909. Copious night-sweats, cardiac palpita- 

 tions. Circumference of the throat 38 cm. Alimentary glycosuria negative. 



Pigmentation on the face, hands, and neck o.ooi gm. adrenalin subcutaneously, no sugar. 



Fifth entrance to the clinic, November, 1909. Circumference of the neck 35 cm. 

 Heart enlarged, extra systoles; Chwstek negative. 



Sixth entrance to the clinic, April, 1910. Alimentary glycosuria (100 gm.) negative. 

 Adrenalin o.ooi gm., no sugar. 



Three thyroidin tablets administered thrice daily for three days, the pulse rate was 

 somewhat increased. Cardiac palpitations slight, the neutrophilic leucocytes are from 

 71.5 per cent, to 84 per cent. Alimentary glycosuria after the beginning of thyroidin 

 medication negative (confer Falta, Newburgh, and Nobel). 



X-ray: The sella turcica is destroyed to the extent that its site is no longer sharply 



FIG. 48. FIG. 49. 



Case of acromegaly (Observation XXXI). 



delimited below and in front; it has given place to a cavity about the size of a chestnut. 

 The anterior clinoid processes are replaced by washed-out bone masses; this is true also of 

 the greater part of the floor, especially anteriorly. The somewhat enlarged clivus pro- 

 jects forward as a characteristically nipple-shaped mass. 



Lately the patient has developed a pronounced cachexia. To this are added slight 

 signs of a myxedema, especially a cushion-like thickening of the backs of the hands and of 

 the skin of the supraclavicular fossae. The pulse rate in the fever-free intervals (the 

 patient now frequently suffers with bronchopneumonias) is about 70; the blood-pressure 

 (Gartner) lies near the figure 70; the former rather frequent diarrheas now occur only in 

 single isolated attacks. There is mostly constipation. The circumference of the throat, 

 it is true, has indeed increased, but a myxedematous thickening of the soft parts may 

 indeed play a part in it. 



The behavior of the thyroid gland in this case is instructive. We are 

 dealing with typical case of acromegaly, which for a long time has shown signs 



