ACROMEGALY 835 



found a "surprisingly large number of sweat glands of large size" in sec- 

 tions of the skin. Falta points out that hyperidrosis occurs independently 

 of increased thyroid activity and must be a feature of acromegaly as such. 

 According to Hinsdale the electric conductivity of the skin is increased, as 

 is the case in Graves' disease, the decreased resistance ("Vigouroux's 

 sign") being attributed to dilated cutaneous blood vessels. 



The Muscular System 



Muscular weakness is a notable feature except in the early stage and is 

 attributable to the endocrin disorder rather than to any primary muscular 

 affection. Extensive muscular atrophy is rare though in a case reported by 

 Duchesneau it was sufficiently marked to lead him to assume the existence 

 of an a acromegalic myopathy," but this has not been borne out by further 

 experience. Equally rare are signs of true myasthenia, the only observa- 

 tions of myasthenic reaction being those of Franchini and Giglioli who 

 maintain that the asthenia in acromegaly reaches a degree only equaled in 

 true myasthenia gravis and Addison's disease. Those who have mtide his- 

 tologic examination of the muscles generally dwell on the degenerative, 

 atrophic and sclerotic changes. Martinotti believes this stage is preceded 

 by one of hypertrophy as he observed an increased diameter of the muscle 

 fibers and proliferation of the sarcolemma nuclei. Brooks also observed 

 mitoses in these nuclei. The supposition that a preliminary stage of mus- 

 cular hypertrophy exists is greatly strengthened by the fact of the charac- 

 teristic bony hypertrophy at points of muscular insertion which we have 

 described as being the most striking skeletal change. 



The Upper Respiratory Tract 



Enlargement of the nose, especially in width, is a regular feature and 

 involves bones, cartilages, and soft parts. The larynx also shares in the 

 hypertrophy. The voice grows deeper, harsh, or guttural, a condition 

 which is ascribed largely to changes in the larynx, and partly to the en- 

 largement of the accessory sinuses (Marie). The acromegalic larynx has 

 been the subject of special studies. Chappell described a patient who died 

 during an attack of dyspnea. The epiglottis was thickened, the arytenoid 

 cartilages and the ventricular bands were enlarged and the glottic aperture 

 was very small. Chevalier Jackson gives a detailed description of the 

 laryngoscopic appearances in four patients, one of whom required trache- 

 otomy for laryngeal stenosis and some time later died suddenly, apparently 

 of asphyxia. "External palpation of the larynx revealed it to be of enor- 

 mous size, the enlargement seeming even and symmetrical. (Fig. 17.) 

 Laryngoscopic examination showed a general overgrowth of the larynx. 



