840 PETEE BASSOE 



Thyroid. This gland is usually diseased. Furnivall found it normal 

 in only five of 29 cases. The pathologic changes, however, are very varia- 

 ble. Whfle hypertrophy is common, combination with actual Graves' dis- 

 ease is rare. It did not exist in any of Cushing's numerous cases but has 

 been reported by a few others (Murray; Lancereaux ( & ) ; Anders and 

 Jameson). Myxedema received early mention by Ponfick(&), and the re- 

 lation of the two conditions is thoroughly discussed by Millioni who 

 observed both fully developed in one patient, Such a case is also described 

 by Greene. 



Parathyroids. No account of lesions of these organs or of signs of 

 tctany have been met with. 



Thymus. Dullness over the manubrium sterni is not a reliable sign of 

 enlargement of this organ on account of the bony thickening. However, 

 persistent thymus has frequently been found post mortem (Gushing, case 

 II, Claude and Bauclouin, Eltester and Schroeder, Ausch and others). In 

 Yamacla's clinically typical case the thymus was greatly enlarged and 

 there was a marked status lymphaticus but the hypophysis is said to have 

 been perfectly normal. 



Adrenals. Pigmentation of the skin, asthenia and low blood pressure 

 suggest adrenal insufficiency, and in a few cases high blood pressure has 

 been attributed to adrenal overactivity (Gushing). The adrenals have 

 often been found enlarged at necropsy (Amsler, Ausch, Eltester and 

 Schroeder, Mullaly(a), Harbitz, etc.). 



Pancreas. Its possible, but contested, relation to the frequent glyco- 

 suria is discussed elsewhere. It has frequently been found enlarged in 

 connection with general splanchnomegaly, hence the importance of the en- 

 largement of a particular organ is less obvious. 



Pineal Body. Few observations are available. Bartlett found it- 

 enlarged to twice its normal size in a case of acromegaly with polyglandu- 

 lar involvement. Schultze and Fischer report a similar case, Sexual 

 hyperactivity preceded the impotence in this case which is of interest in 

 connection with the sexual precocity observed in children with pineal 

 tumor (see chapter on Gigantism). 



Psychoses 



We have already discussed the tendency to apathy, lassitude, drowsi- 

 ness and mild depression present in very many cases. The first case re- 

 port of a true psychosis in connection with acromegaly is probably that of 

 Arnold Pick (1890), as Souza-Leite, in his thesis of the same year, stated 

 that, while there is a tendency to depression to the point of suicidal desire, 

 actual insanity had not been observed. These milder mental changes were 

 noted in 10 of his 38 collected cases, and in four of Duchesneau's 14 addi- 

 tional cases (1891). A good example of a borderline state is related by 



