ACROMEGALY 



827 



t 



elbows and knees. Lipping is fairly well marked in the wrist and ankle 

 joints but destruction of the articular cartilages is comparatively slight 

 All of the arthritic changes are less marked in the joints of the hands 

 and feet but the ends of the terminal phalanges of both show marked bonv 

 overgrowth. (Fig. 14.) There 

 are pea-sized depressions on the 

 plantar surfaces of the proximal 

 ends of the terminal phalanges 

 of the thumbs, and correspond- 

 ing smaller depressions on the 

 other phalanges, produced by 

 absorption at the base and hy- 

 perostosis at the margins of 

 ligamentous insertions. 



The shafts of the humerus, 

 radius, ulna, and tibia show 

 little change aside from slight 

 sharpening of crests and points 

 of muscular insertion, especially 

 on the upper part of the hu- 

 merus. The fibulae show marked 

 deepening of the grooves, with 

 reduction in volume and thick- 

 ening of the crests, making a 

 triangular fluting. The coronoid 

 processes of the ulna are 

 enormously elongated which 



, ill Fig. 14. Rontgenogram of hand. (Case 



must nave reduced the range O f Dean Lewis.) 

 of motion at the elbows. The 



sesamoid bones of the great toes show considerable marginal hypertrophy. 

 The metacarpal and metatarsal bones show a flattening or grooving 

 of the surfaces of the shafts at points of attachment or contact with 

 the interosseous muscles. The phalanges, especially those of the first 

 and second rows, are flattened on their plantar and palmar surfaces 

 from contact with the flexor tendons. There is slight lipping along the 

 sides of these flattened or grooved surfaces. 



General Features of Conformation of the Body and 

 of the Skeletal Changes 



The appearance of the acromegalic suggests coarseness and brutishness, 

 and at the same time his frequent feebleness and tottering give him an 

 aspect of senility. In fact, both of these features have been commented 



