THE SYMPATHETIC SYSTEM 177 



In women the menses decrease or stop altogether. 

 Finally, to this disease is often associated a remarkable 

 splanchnomegalia; the heart is enlarged, without any 

 apparent cause. The liver and spleen are also increased 

 in size. 



CLINICAL TYPES. 



Certain cases of acromegalia are associated with muscular 

 atrophies (amyatrophic cases), with various neuralgias, 

 intercostal or sciatic (painful cases), when as a result of 

 lesions of the vertebra, the roots are compressed. 



There are also mild forms characterized by elongation 

 of the face, proliferation of the inferior maxillary, a slight 

 kyphosis, a more or less noticeable enlargement of the 

 hands and feet, which "is more a condition than a dis- 

 ease." (Chauffard). 



EVOLUTION. 



Acromegalia usually starts around 25 or 30, very insidi- 

 ously. In the majority of cases the patients notice that 

 they have to get larger and larger sizes of hats, gloves and 

 shoes, or their friends notice the deformities of the face. 



The evolution is usually very slow, but progressive; 

 there are, however, periods of remission. The hyper- 

 trophy may remain stationary for several years without 

 interfering with health. The disease may last 20 or 30 

 years. In other cases, the evolution is much more 

 rapid and the patients die after 3 or 4 years with sign of 

 brain tumor. 



ETIOLOGY. 



Acromegalia is caused, in the great majority of cases, by 

 a tumor of the pituitary. The gland which normally 

 weighs 0.50 centigrams, can reach a weight anywhere 



from 3 to 40 grams and become very large. The tumor is 

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