PATHOLOGICAL ANATOMY OF THE HYPOPHYSIS 281 



stance a cranium progeneum in many other conditions that have nothing to 

 do with acromegaly (Sternberg) . Confusion with osteitis deformans of Paget 

 is hardly likely on careful examination. In osteitis deformans the cranium 

 is enlarged chiefly in circumference, the long bones soon show curvatures, 

 the alterations in the skeleton are very asymmetrical. In osteoarthropathie 

 hypertrophiante pneumonique the skull remains unaltered, only the nose may 

 be larger. In this condition we have a dorsolumbal kyphosis, in acromegaly 

 a cervicodorsal kyphosis; the end phalanges show the well-known drumstick 

 form, the nails show curving and longitudinal ridges; while chiefly the region of 

 the knuckles is very much swollen up, the metacarpal and metatarsal region, 

 as Souza Leithe points out, show but slight increase in volume. Under cir- 

 cumstances there may occur in the osteoarthropathy club-like swellings of the 

 hands and feet, that may have given occasion to confusion with acromegaly 

 (confer the case of Schultz and Fischer}. Combination with symptoms of 

 Basedow's disease or myxedema may in the beginning occasion an overlooking 

 of the acromegaly. Early 'genital disturbances or rheumatoid pains may 

 lead to a faulty diagnosis. Syringomyelia may also lead to an increase in 

 volume of the extremities, but in this condition there are usually found in 

 addition deformations and the well-known dissociation of the sensation- 

 qualities. In ordinary macrosomia only single members are affected, never 

 both upper extremities and both lower extremities simultaneously. Cases 

 in which hands and feet were enormously enlarged I have already discussed 

 in the consideration of early acromegaly (Pel, Demmer). We must not for- 

 get that the acra of the face may begin to become enlarged very much 

 later. Erb saw such a case; the enlargement of the extremities had existed 

 for about twenty years before the tongue and nose began to enlarge. 



Finally we must refer to the significance of the demonstration of the 

 enlargement of the sella turcica by Rontgen transillumination, as first demon- 

 strated by Oppenheim. 



In acromegaly there is usually found deepening of the floor of the sella 

 without material widening of the introitus, while in the tumors of the 

 hypophysis without acromegaly dilatation of the introitus and destruction 

 of the clinoid process is commoner, although there are exceptions. 



Important for a differential-diagnostic standpoint is, finally, the cir- 

 cumstance that genital disturbances may occur. Salbey reports a case in 

 which oophorectomy was undertaken because of amenorrhea and pains in 

 the back and abdomen. Several months later there developed a picture of 

 acromegaly. 



Until lately the treatment was utterly ineffective. Striking results were 

 irst brought about by the resection of the hypophysis tumor first inaugu- 

 rated by Horsley,bySchlo/er, and byv. Eiselsberg and first happily carried out 

 by Hochenegg. I refer to the consideration of hypophysial dystrophy for 

 a discussion of the method of operation. In the first two cases of Hochenegg 



