GIGANTISM 461 







The ovary on each side was very small, and changed into glandular masses. 

 The hypophysis was enlarged, the sella turcica was destroyed, the mammae 

 were entirely hypoplastic. 



I believe that the examples I have furnished suffice to show the enormous 

 multiplicity of the manifestations of the pathological forms of giant growth. 

 The symptoms of eunuchoidism or late eunuchoidism are combined with 

 those of acromegaly in the most diverse ways. If we disregard, however, 

 the quite rare cases of pure eunuchoid gigantism, we find indeed that the mani- 

 festations of eunuchoidism and late eunuchoidism, are very common, while 

 the manifestations of acromegaly are present almost always regularly, or 

 that they develop later. In this connection the classification of pathological 

 giants of Launois and Roy is very correct, even if it is not just to the uncom- 

 monly numerous types. . 



Pathogenesis. If we now turn to a pathogenesis of gigantism, our 

 first task will be to test whether the formula of Brissaud-Meige, which also 

 has been adopted by Launois and Roy, is in the position to explain the mani- 

 fold types of gigantism. Brissaud and Meige have expressed the opinion 

 that gigantism is nothing other than an acromegaly beginning in early 

 youth, that is, before the closure of the epiphyses. A great difference be- 

 tween acromegaly and pathological gigantism exists, first of all, in the be- 

 havior of the sexual glands. I must here again point out the fundamental 

 difference in the relation of the glands of generation and the interstitial 

 glands in typical acromegaly. The first show temporary increase of their 

 function, but then there very commonly occurs very premature disturb- 

 ances or entire loss of their function, whereas the function of the interstitial 

 glands is rather more emphasized, or at all events, apart from very rare cases, 

 shows no disturbance in the course of the disease. In gigantism we see this 

 behavior in but a few cases. In the majority of cases the manifestations of 

 eunuchoidism are prominent from the beginning, or later there occur mani- 

 festations of late eunuchoidism. In the description of early acromegaly a 

 similar behavior of the sexual glands has been noted. 



There cases were described in which also the interstitial glands showed dis- 

 turbances of their function, in this respect lending countenance to the Brissaud- 

 Meige' s formula. There also we learned about sure cases of acromegaly, that 

 came to manifestations of acromegaly while the epiphysial junctures were still 

 open. Increase of function of the hypophysis alone, hence, does not lead to 

 gigantism. We must assume in addition to it a potential tendency to growth, 

 that may be either proportionate (normal giants) , or as it is mostly, dispro- 

 portionate, partly through a preponderance of the function of the hypophysis, 

 partly through an insufficiency of the interstitial glands and probably also 

 through many other factors. While in acromegaly we certainly find a 

 tendency to hyperf unction and hyperplasia of other ductless glands in which, 

 however, always the increase in function of the hypophysis remains quite in 



