810 PETEK BASSOE 



nent, and the sella turcica was enlarged. The patient began to show mor- 

 bid hyper sensitiveness at 12 years, with varying moods, and hallucinatory 

 episodes. Tucker's second patient had a similar precocious development, 

 mental symptoms of exaggerated hysterical type, enlarged sella and hyper- 

 trichosis, but otherwise no feaures of acromegaly. To Gushing, however, 

 belongs the chief credit for clarifying our views. In his masterly mono- 

 graph based on an unequaled array of carefully observed and brilliantly 

 analyzed cases of all kinds of pituitary disease he, first of all authors, has 

 given a time perspective and showed with unerring logic that the mor- 

 phologic entity, acromegaly, is the end result of anterior lobe hyperfunc- 

 tion of long or short duration, with or without admixture of symptoms 

 produced by previous or subsequent hypophyseal hypofunction, disorder of 

 other ductless glands, pressure upon or erosion of neighboring brain struc- 

 tures, and symptoms of increased intracranial pressure caused by the 

 purely mechanical effect of the hypophyseal tumor. Gushing, Oppenheim, 

 and Heinicke have shown that hyperpituitarism and the syndrome acro- 

 megaly may be produced by hydrocephalus (secondary to cerebellar tumor 

 in the cases of Gushing and Oppenheim). 



With this precision of our view of the syndrome of acromegaly as the 

 morphologic expression of a past or persistent state of hyperpituitarism we 

 are prepared to view the various features in greater detail without losing 

 our bearings. Many apparent contradictions in earlier descriptions are 

 due to the failure of the authors to distinguish between active and quies- 

 cent, primary and secondary states, between glandular, neighborhood, and 

 general pressure symptoms. 



General Description. The early symptoms generally consist in a 

 changed appearance of the features which become coarse on account of 

 thickening of the nose and lips, enlargement of the tongue and lower jaw, 

 and prominence of the superciliary ridges. The skin and subcutaneous tis- 

 sues are thicker, often the skin is darker, rougher and thrown into folds. 

 The hairiness of the body increases. This is particularly conspicuous in 

 women, who may develop a heavy growth of dark hair between the breasts, 

 and on the abdomen and legs, and sometimes also a beard such as more fre- 

 quently is seen in very old women. In women the coarseness and huski- 

 ness of the voice and a general tendency to a masculine conformation of 

 the body are noted. Amenorrhea is an early feature while in men a period 

 of increased sexual activity frequently precedes the later almost constant 

 decreased sexual power or impotence. Following enlargement of the lower 

 jaw the hands and feet increase in size, generally more conspicuously in 

 width than in length, and, as shown by rontgenologic examination, the 

 enlargement is chiefly of the soft parts, though later a decided bony hyper- 

 trophy may follow. While the hands and fingers usually are notably broad, 

 Marie early recognized a type of elongated hand as well. 



Among the early subjective symptoms headache, pain in the face, and 



