ACROMEGALY 81 7 



years, and the menses had been absent for two years. Within a year her 

 face and hands assumed acromegalic appearances, an abundant growth of 

 hair appeared on the legs and lower abdomen, the latter giving to the pubic 

 hair a male appearance. The breasts atrophied and the buttocks assumed 

 a male contour. The sella was found to be enlarged, with thinning of the 

 anterior and posterior clinoid processes. The color of the face changed 

 from a blond and rosy hue to a dark color with a yellowish reflection, and 

 the skin became rough. This case well illustrates the tendency of the sec- 

 ondary sexual characteristics of the female to change to the male type 

 during "acromegalization" while those of the male become exaggerated. 



A series of seven arrested cases, similar to those of Schlesinger, is re- 

 ported by Hillel. The most striking one is the last case, a man of forty 

 years, with onset at fourteen years and active enlargement of the usual 

 kind until twenty. Then the condition remained stationary. Potency 

 was retained, and he became the father of two healthy children. There 

 were no ocular symptoms. In another man the potency was retained, as 

 was menstruation in four women. 



Primary Symptoms and Lesions 

 The Skeletal Changes 



Thanks to the kindness of Dr. Dean Lewis we may introduce the de- 

 scription of the skeletal changes by relating the following case in which 

 necropsy was performed immediately after death and the skeleton subse- 

 quently prepared. 



A man 40 years old, an inmate of the Illinois Industrial Home for the 

 Blind, was admitted to the service of Dr. Dean Lewis in the Presbyterian 

 Hospital, Chicago, in February, 1913. There was some Indian blood in 

 his ancestry on his mother's side. Eight years previously he had noticed 

 that his head was growing larger as his hats became too small. A year 

 later he had the same experience with his shoes. After another year his 

 vision began to fail. In 1910 he became blind. He presented a very 

 striking picture of advanced acromegaly (see Figs. 2, 3.) with extreme 

 prognathism, immense superciliary ridges, large nose, hands and feet. The 

 skin was very thick and leathery and the hair was thick and course. He 

 measured 6 feet 2 inches in height and weighed 250 Ibs. His sugar toler- 

 ance was found to be within normal limits. During the following years 

 there was no change in his condition. In January, 1920, he developed 

 pneumonia, was admitted to the service of Dr. W. E. Post in the Presby- 

 terian Hospital and died after an illness of a few days. At the necropsy, 

 held by Dr. B. O. Eaulston, a large hypophyseal adenoma was found. It 

 weighed 46 grams. The circumference of the head was 63.5 cm., the 



