PATHOLOGICAL ANATOMY OF THE HYPOPHYSIS 277 



believing that in the majority of cases a premature degeneration of the 

 insular apparatus seems the most likely explanation. 



Pathological physiology has as yet furnished with very little for the 

 understanding of the pathogenesis of acromegaly. As yet just the most 

 important symptoms, the increased tendency for growth of a certain part of 

 the organism, especially the osseous system, have not been reproduced ex- 

 perimentally. In spite of this the supposition of a hyperfunction of the 

 hypophysis in acromegaly is to-day the only satisfactory one. 



For this assumption speaks: 



1. The opposition of the clinical pictures of acromegaly and hypophysial 

 dystrophy. 



2. The fact that the latter may be produced by extirpation of the 

 hypophysis. 



3. The results of surgical interference. 



4. The analogy with affections of the thyroid gland. 



Early Acromegaly. The statements thus far set forth as to the patho- 

 genesis of acromegaly are concerned with the clinical picture that we meet 

 with in adults. Acromegaly indeed develops almost exclusively after the 

 twentieth year. We must now consider the important question as to whether 

 there exists an acromegaly of child or adolescent life, and whether the picture 

 of early acromegaly deviates from that of adults. Brissaud, and Launois and 

 Roy adopt the view that hyperfunction of a hypophysis in early youth before 

 the closure of the epiphysial juncture leads to gigantism and after the definite 

 ending of growth to acromegaly. According to this view all pathological 

 gigantism would then be acromegaly. This view was already vigorously 

 opposed by Pierre Marie. I shall deal with this question later in the chapter 

 on gigantism, and only would remark here, that I also cannot subscribe 

 to this view, as may be plainly seen on the perusal of the following details. 

 I believe much more that there exists an early acromegaly with gigantism; 

 only it seems that this condition is relatively very rare, and is much more 

 manifold as to its symptomatology than is the typical acromegaly of adults. 



It here seems to me necessary to enter more in detail concerning the re- 

 ports on this subject that occur in the literature. Most intelligible is a group 

 of cases in which the clinical picture is very similar to the acromegaly of 

 adults. To this group belongs the case described by Arnold as early as 1891. 

 According to the definite statement of the author the acromegalic manifesta- 

 tions in this patient began to develop distinctly in the eighteenth year of life. 

 In a brother of the patient, who also suffered from acromegaly, the be- 

 ginning of the affection came on at a still earlier period of life. There is 

 no doubt at all that this case was one of acromegaly; this was shown by the 

 typical thickening of the bones that increased in intensity toward the 

 periphery. Also the exact microscopical examination of the bones showed 

 architecture typical for acromegaly. In the muscles, in the peripheral nerves, 



