816 PETER BASSOE 



cropsy revealed a cherry-sized adenoma of the hypophysis, syphilitic aorti- 

 tis, arthritis deformans, thyroid adenoma, hypertrophy and fresh hemor- 

 rhages of 1>oth adrenals. The second patient was a woman of 63 years, 

 with onset of acromegaly at about 17. She had Argyll-Eohertson pupils. 

 Death was from papillary carcinoma of the ovary, and the necropsy also 

 revealed adenoma of the hypophysis. The third patient, a male, 56 years 

 old, had acromegaly from early youth, and came to the hospital on account 

 of lymphatic leukemia. The sella was not enlarged. He was under 

 observation for many years, during which there was no variation in the 

 acromegalic symptoms. The fourth patient, a. man of 63, with a diabetic 

 sister, had large hands and feet from childhood. The nose and lips were 

 large. Kyphosis was present and the tibiae were uneven. The sella turcica 

 was normal on rontgenologic examination. The Wassermann test was 

 negative. The sugar tolerance was not increased. Marked edema of the 

 hands and feet was present and thought to be of the nature of trophedema 

 which rarely exists in acromegaly and is thought by the author possibly to 

 indicate a polyglandular disorder. Ocular symptoms (except early tem- 

 porary ones in the second patient), headache, and other symptoms of in- 

 creased intracranial pressure were absent in these cases, and nothing was 

 elicited to indicate that sexual function had been impaired. The author 

 does not state whether any of these patients left offspring. The fact that 

 all of them showed typical changes in the conformation of the face, in the 

 absence of visual impairment and sellar enlargement, confirms the signifi- 

 cance of these changes in the face when occurring in youth. It is regret- 

 table that the exact history of the evolution of the disease during child- 

 hood and early youth in these cases is not known. They probably belong to 

 the "pluriglandular syndrome," so well described by Timnie(a.)? and have 

 passed successfully into the fourth or compensated stage, as 'thus exempli- 

 fied by him: "A woman, 33 years of age, with typical acromegaly 

 hands, feet and skull abnormalities, was admitted for some minor ailment. 

 Her history showed that she began to menstruate at 19 years, had intense 

 headaches at 25 years which for three years resisted all attempts to alle- 

 viate, and during whose persistence she began to grow acromegalic. When 

 the headaches spontaneously ceased, the abnormal growth ceased, and she 

 passed an uneventful life to the time of the present slight ailment. Her 

 childhood and adolescence were like those described in the first two stages 

 of this syndrome f atigTiability being the prominent symptom. Her acro- 

 megaly, then, was completed at about the twenty-ninth year, did not further 

 increase, and she remained well for twenty-three years longer." C. S. 

 Williamson reports a case in a man of 30 years in whose symptoms there 

 had been no progression for twelve years during which he had gained 90 

 Ibs. in weight. 



Climenko and Strauss relate a case at an earlier stage of a similar pro- 

 cess. A woman of 22 years had suffered from severe headache for three 



