ACROMEGALY 259 



of hyperthyroidism (sweats, tachycardia, tremor, slight exophthalmus, 

 diarrhea, etc.). Later with the development of a cachexia, symptoms of 

 hyperthyroidism retrogress more and more, to give place to a slight thyroid 

 insufficiency. 



The regressive changes in the thyroid gland that so frequently become 

 established in the later stages of acromegaly might well be regarded as a 

 partial phenomena of the degenerative alterations that in the later stages of 

 acromegaly involve not only these organs that are the seat of the tendency to 

 growth fostered by the acromegaly, but also the entire body as well. Hence 

 in the later stages of acromegaly we may often see myxedematous symptoms, 

 even in the absence of previous manifestations of hyperthyrosis. Pineles 

 reports two cases of acromegaly with myxedema of the skin, stupidity, and 

 weakness of memory. Improvement of the myxedema symptoms followed 

 the administration of thyroid gland, although they were not influenced by 

 hypophysis tablets. 



The pathologico-anatomical finding in the thyroid gland in acromegaly 

 almost always shows something abnormal. When hyperthyrosis has existed, 

 there is found the picture of a Basedow's struma. Otherwise there is seen 

 almost always connective tissue proliferation, such as is found also in other 

 organs in acromegaly, or coltoid degeneration in combination with, eventually , 

 high-grade sclerosing and atrophy of the parenchyma. Gaussel found a 

 thyroid gland that was normal. 



The vascular system in the later stages of acromegaly almost always shows 

 changes. A slight grade of arteriosclerosis develops. Microscopical examina- 

 tion shows that the three vascular coats are involved in these changes, and 

 that the media becomes poor in muscle fibers. The heart not infrequently 

 hypertrophies, and the cardiac muscle soon degenerates. Especially those 

 cases that are attended with other symptoms of Basedow's disease often 

 show in the initial stages a slight degree of tachycardia; in all cases manifesta- 

 tions of insufficiency of the heart-muscle develop in the later stages. Varices 

 are strikingly frequent. 



In many cases the enlargement of the heart may very well be a partial 

 manifestation of the true splanchnomegaly. Humphry describes a consider- 

 able cardiac hypertrophy without valvular changes in a man aged thirty-nine 

 years. The case reported above (Observation XXIV) there was a broaden- 

 ing of the cardiac shadow, on X-ray examination, to 13 cm. The patient 

 was thirty-two years old. Not rarely in addition to the enlargement of the 

 heart there is found an enlargement of the liver, the spleen, the stomach, 

 and the intestines. The enlargement of the liver is often only the sequel of 

 an existing cardiac insufficiency, sometimes, however, the partial manifesta- 

 tion of a true splanchnomegaly. The enlargement of the spleen is a partial 

 manifestation of the enlargement of the lymphatic apparatus to be described 

 later. The dilatation of the stomach has been brought into association with 



