834 PETEK BASSOE 



brachy or dolichocephalic. Gibson, Fitzgerald, Fearnsides and Peritz 

 contribute further data on the normal and abnormal sellae. According to 

 Gushing theVe are three principal types of the pathologically deformed and 

 enlarged sellae: (1) that associated with thickening of the clinoid pro- 

 cesses and dorsum ephippii; (2) that with thinning from pressure absorp- 

 tion of these parts, and (3) that with more or less destruction of all out- 

 lines. The first type, he says, is confined to the cases of acromegaly and 

 gigantism which are uncomplicated by adenomatous struma formation, 

 and the thickening is explained by the general tendency toward osseous 

 overgrowth. 



The Skin and Its Appendages 



The skin is usually rough, thickened and thrown into folds. The con- 

 dition in some respects resembles myxedema, and, as pointed out by 

 Striimpell, is the opposite of scleroderma. The puffiness of the skin is 

 most marked in the palms and soles. The cutis vera is thickened, and 

 hypertrophy of the papillae is marked so as to cause them to project like 

 small polypi. The epidermis is rather thin on account of its being 

 stretched over the papillae (Dalton). Unlike the skin of myxedema, that 

 of acromegaly in spite of its sclerotic condition may be raised into folds. 

 In rare instances the scalp is thrown into large folds resembling cerebral 

 gyri, hence the term " : cutis verticis gyr&ta" described in acromegaly by 

 Sabat and by Adrian and ascribed to the more rapid growth of the skin 

 than of the bone. 



Pigmentation of the skin occasionally may be marked, and its resem- 

 blance to that of Addison's disease suggests associated adrenal changes 

 (Climenko and Strauss; Bendell). Acanthosis nigricans in both axillae is 

 described by Fahrseus and attributed to the adrenals. 



Mollusca fibrosa are frequent and sometimes sufficiently abundant to 

 constitute von Recklinghausen's disease. Combinations with the latter 

 disease are reported by Wolfsohn and Marcuse and by Nicolas and Favre. 



More or less hypertrichosis is the rule and it is usually pronounced in 

 cases of marked cutaneous pigmentation. One of Gushing' s male patients 

 (case XXV in his monograph) had excessive growth of hair all over his 

 trunk and arms, marked brownish pigmentation in the groins and about 

 the navel, general asthenia and low blood pressure. Falta(fr) has made 

 similar observations. Ausch observed the previously blond and soft hair 

 of an acromegalic and diabetic man of 38 years turn black and coarse. 

 The hairy growth was not excessive except on the face and lower abdomen. 

 A polyglandular affection existed since necropsy revealed enlarged thyinus, 

 thyroid and adrenals, with histologic changes in the latter. The nails may 

 be striated and appear too small for the enlarged fingers. 



Both sebaceous and sweat secretion are prone to be increased. Brooks 



