ACEOMEGALY 837 



quently observed adrenal hyperplasia and in the presence of pressor sub- 

 stances in the blood (Humphrey and Dixon; Amsler). There is a ten- 

 dency to increase in blood pressure (Peritz). Some of the earlier authors 

 (Klebs, Brooks) lay great emphasis on the changes in the blood vessels 

 which they maintain are among the earliest observed. According to J. B. 

 C. Fournier two varieties of enlarged heart are met with: one due to 

 simple cardiomegaly with normal muscle and very rarely associated with 

 valvular insufficiency ; the other with veritable interstitial myocarditis and 

 accompanied by signs of arteriosclerosis and impaired heart's action, 

 passive congestion of the liver, edema of the extremities, etc. , This author 

 also believes that the deformities of the spine may lead to dilatation of the 

 right side of the heart. 



Varicose veins and hemorrhoids are common. Signs of Kaynaud's 

 disease, such as blueness and coldness of the hands, have been observed 

 (Boettiger, Oeconomakis) but in some of the reported cases the presence 

 of acromegaly was not proven. 



Paroxysmal hemoglobinuria and joint swellings of the nature of inter- 

 mittent hydrops were noted by Chvostek. Dunn observed attacks of 

 hemoptysis ascribed to transient hemorrhagic edema of the lungs. 



Metabolic Disturbances 



Glycosuria. In 176 cases of acromegaly collected from the literature 

 up to 1908, L. Borchardt found 63 complicated with diabetes, and in eight 

 other cases with alimentary glycosuria, so that in 71 cases, or 40.32 per 

 cent, an abnormal carbohydrate metabolism was demonstrable. In some 

 cases sugar appeared in the urine only occasionally and, in general, the 

 glycosuria is remarkably independent of the diet. He believes that the 

 glycosuria is caused by hyperfunction of the hypophysis as he succeeded 

 in producing glycosuria in rabbits by subcutaneous injection of pituitary 

 extract. By a series of control experiments he convinced himself that the 

 glycosuria was not produced by admixture of epinephrin. 4 Cushing's 

 experiments gave similar results, and he also found that administration of 

 posterior lobe extract lowered the sugar tolerance to normal or below nor- 

 mal in animals in which it had been raised by excision of the posterior 

 lobe. He associates glycosuria especially with the early and active stages 

 of acromegaly. His finding of glycosuria in a case of hemorrhage into the 

 posterior lobe of the hypophysis after skull fracture is also very sugges- 

 tive. Labbe points out that when acromegaly and diabetes coexist the 

 former appears first, and that polyuria is likely to persist after the sugar 



4 On a priori grounds the participation of epinephrin in such phenomena is highly 

 unlikely. It would involve complete inhibition of gastro-intestinal peristalsis. R. 

 G. H. ' 



