ACEOMEGALY 815 



extremities and tongue and enlarged sella was complicated by myxedema. 

 Claude's case of acromegaly without gigantism, with onset at 15 years* 

 showed signs of hyperthyroidism, and, according to him, possibly adrenal 

 over-action as the blood pressure was increased. The epiphyses in the 

 hands and feet were closed at 18, hence growth in length was impossible. 

 Sicard cautiously uses the term "acromegalism" rather than acromegaly in 

 connection with two brothers, both of whom developed enlargement of the 

 hands at 18 years, later of the feet, and in both there was the unusual 

 feature of such marked enlargement of the tarsal cartilages that the eyes 

 could be only partially opened. In addition to the case previously men- 

 tioned Pel (a) describes a boy of 16 years, 197 cm. tall, hence to be consid- 

 ered a giant, who in spite of his youth had hands and feet of acromegalic 

 appearance, but there was a suspicion of congenital syphilis since the father 

 had this disease. HutinePs case of a mentally defective and obese boy of 

 13 years with large tongue, lips, and feet, and enlarged sella, was probably 

 complicated by syphilis as interstitial keratitis was present, as well as sus- 

 picious changes in the teeth and tibiae. Valdes describes a negro boy of 

 14, with onset at 12 of lassitude and enlargement of the hands, feet and 

 lower jaw. The lower teeth projected beyond the upper. Cervicodorsal 

 kyphosis was also present. 



A noteworthy case in a child is that of Franchini and Giglioli, already 

 mentioned in connection with heredity since the father also had acro- 

 megaly. At twelve years the daughter began to have headache and became 

 depressed, easily exhausted, drowsy and taciturn. Gradually the face, 

 hands and feet became enlarged. When the patient was observed at four- 

 teen the menses had not yet appeared ; the sella turcica was enlarged but 

 there were no ocular symptoms. 



Kenon, Dellille, and Monier-Vinard in 1908 described a girl, 16 years 

 old, who developed headache and disturbance of vision at twelve years and 

 then began to grow rapidly, attaining a height of 168 cm. at 16 years. 

 The optic discs were atrophic, the right eye blind. The limbs were dis- 

 proportionately long. This case was later (1914) reported by Beclere as 

 greatly benefited by X-ray treatment ; the headache was relieved, the vision 

 improved and menstruation reestablished and there was no further prog- 

 ress of skeletal changes. 



An interesting group of four cases of acromegaly, all observed after the 

 age of 55 years, but with onset at about puberty, is reported by Schlesin- 

 ger. In all of them the disease had remained stationary for 40 to 50 years 

 and the patients came under observation on account of other ailments. 

 The first patient, a man of 59, with typical aeromegalic features which 

 were present in a photograph taken at fifteen, had a very large heart with 

 mitral and tricuspid insufficiency. The urine contained a large amount of 

 sugar. He had contracted syphilis at twenty and gave a positive Wasser- 

 mann reaction. The skull was hyperostotic, the sella not enlarged. 



