AGROMEGALY 839 



bones to a male type. The penis, and particularly the clitoris, may par- 

 ticipate in the general enlargement of end segments ("acra"). 



Sexual desire and power remain intact or may be increased during the 

 early stages in most cases, but almost invariably a subsequent rapid de- 

 cline takes place, hence in the fully developed disease impotency in the 

 male and amenorrhea and sterility in the female are the rule. Blair Bell 

 ascribes the amenorrhea to the above mentioned tendency to masculinity. 

 Falta knows of only two instances of conception during acromegaly, one of 

 his own cases and that of Pirie. This latter patient was a woman of 43 

 years who conceived three months after the onset of amenorrhea and other 

 acromegalic symptoms. She developed a beard, the hair on her head 

 "stood straight upwards," there was yellow bronzing of the skin of the 

 face, chest and inside of the thighs. The vagina and clitoris were large. 

 Several other cases may be added, e. g., that of Kalleday in which a nor- 

 mal pregnancy followed three months of ovarian treatment, and that of 

 Tibor in which at least two out of ten pregnancies occurred after the onset, 

 and menstruation persisted for ten years after the onset. Boyd looked up 

 the sexual data in 65 reported cases and found loss or decided impairment 

 of sexual function in 68 per cent of the males and 89 per cent of the 

 females. With declining function involution of the testicles, ovaries and 

 uterus takes place so at necropsy these organs usually are found to be 

 decidedly atrophic. 



The discrepancy between the behavior of the secondary sexual char- 

 acters and genital function is now readily understood, thanks to Steinach's 

 important demonstration that the former depend entirely on the intersti- 

 tial cells of Leydig so we merely have to assume a preliminary stimula- 

 tion or hyperplasia of these structures which process may be connected 

 with and at least is followed by decreased activity of the tubular sexual 

 glandular structures. 



Milk secretion sometimes appears from activation of the mammary 

 glands. Bab reports the case of a woman of 35 years whose menstruation 

 ceased from January, 1903, to May, 1904. In the spring of 1903 she re- 

 ceived a psychic trauma by lightning striking near her, and then devel- 

 oped the usual signs of acromegaly. Colostrum appeared and also a 

 growth of hair on the chest. Roth observed milk secretion in a man of 28 

 years, and the nature of the secretion was confirmed by chemical and 

 microscopic examination. Fazio observed galactorrhea lasting for four 

 years. 



Associated Endocrine Disturbances 



Throughout this narrative the interweaving of symptoms attributable 

 to endocrine glands other than the hypophysis has been pointed out. Here 

 we shall merely summarize certain data. 



