ACROMEGALY 263 



pronounced retention of phosphorus, calcium, magnesium, and chlorine (and 

 also nitrogen), and explains this by the increased growth of the tissue. 



Investigations as to purin metabolism have been instituted by Nowaczinsky 

 and me in three cases. There were the cases already described as case T (Ob- 

 servation XXV), U (Observation XXIV), and Ta (Observation XXVII). 

 In case T (thirty-one years old) we found on purin-free diet a uric-acid elimi- 

 nation between 0.72 gm. and 0.92 gm. in twenty-four hours. In case U 

 (thirty-two years old) between 0.89 gm. and 1.16 gm.; fourteen days after 

 the operation still higher values were found. As has already been men- 

 tioned, in this case the operation had no influence on the acromegaly. 

 After the administration of sodium nucleinate there occurred a prompt 

 increase of uric-acid elimination. In case Ta (thirty-three years) there 

 were uric-acid values between 0.72 gm. and 1.29 gm. 



Hence in all three cases were found values for the elimination of endogen- 

 ous uric acid that reached the double or more than the double of the endog- 

 enous uric-acid factor observed in normal individuals. Any complications 

 can hardly be regarded as the cause of this enormous increase. The patients 

 were all free of fever; in case U there existed very slight symptoms of hyper- 

 thyrosis, which was however absent in both other cases. Ta had had lues, 

 but now no symptoms of lues were present. Hence we must assume that the 

 increase of uric-acid elimination in acromegaly occurs as such; the more so 

 because in some cases of hypophysial dystrophia adipiso-genitalis we find 

 strikingly low endogenous uric-acid values. In one case of acromegaly there 

 occurred after the administration of purin-free material a prompt increase in 

 the elimination of uric acid, while in the cases of hypophysial dystrophy the 

 elimination of uric acid was extraordinarily reduced. 



Such high values for the endogenous uric-acid elimination as we found in 

 three cases of acromegaly have as yet been observed only in diseases in which 

 much lymphatic tissue is destroyed, or in certain febrile processes attended 

 with marked hyperleucocytosis (acute articular rheumatism). In the 

 cases of acromegaly the leucocyte counts were rather lower than normal. 

 There was no ground whatever for the assumption of an increased melting 

 down of lymphatic tissue. Further investigations as to this question are 

 very desirable (see Chapter I). 



Lately Dr. Vias has examined a quite chronically progressive case of 

 acromegaly, and has observed no increase in the endogenous uric-acid 

 elimination. 



Quite especially frequent is acromegaly complicated with glycosuria or 

 with diabetes mellilus. Already Pierre Marie had stated that in a third or a 

 half of the cases of acromegaly glycosuria was found. Detailed references 

 to the literature are to be found in the articles of Launois, and Roy arid of 

 Borchardt. 



Borchardt collects from the literature 176 cases of acromegaly in which 



