842 PETEK BASSOE 



in discussing the mental symptoms in cases of intracranial tumor, states that 

 neither the location nor the nature of the tumor can be inferred from them. 



The manic-depressive type of psychosis is the one by far most fre- 

 quently observed in acromegaly, as has been well shown by recent investi- 

 gators, notably Laignel-Lavastine, and Parhon and Stocker. The former 

 author believes thyroid disturbance plays a role in the production of the 

 psychoses. Leri (1908) makes a similar claim for the adrenals, and 

 both of these contentions are supported by numerous reports of changes 

 in these organs in cases complicated by psychosis, several of which have 

 been mentioned here. The case of Gamier and Santenoise previously men- 

 tioned was called "acute mania" and was complicated by goiter. J. Salo- 

 mon observed an acromegalic man with three depressive attacks which were 

 aggravated by administration of hypophysis and improved by thyroid. 

 Parhon and Stacker's patient had two cycles of the manic-depressive psy- 

 chosis which these authors connect with the endocrin disturbance, sup- 

 porting themselves also on the rather numerous reports of the same psycho- 

 sis complicating Graves' disease (Gelma). 



A chronic paranoid state with hallucinations was evolved in Meyer's 

 patient and in that of Goldstein (&) who developed acromegaly after re- 

 moval of the ovaries. Witte pictures and describes an old man who devel- 

 oped acromegaly at 55 and finally was bedridden with numerous somatic 

 symptoms for a long time preceding his death at 69. This man had fleeting 

 hallucinations and delusions which the author explains thus : The patient 

 who had a psychopathic inheritance and small mental endowment could 

 not resist the abnormal stimuli arising from the altered portions of the 

 body and gave them a delusional interpretation. Like other patients with 

 optic atrophy he had subjective visual perceptions, saw men with knives, 

 and soldiers ; olfactory nerve irritation caused him to imagine he smelled 

 burning human flesh with the resulting delusion that he was to be burned ; 

 tactile paresthesias in the hands made him think he was holding his wife's 

 hand; painful sensations, that wire was being wrapped around him; 

 altered pressure sense, that iron bars had been put inside his limbs, etc. 

 Witte adds that this type of psychosis is uncommon in acromegaly in com- 

 parison with depressive and simple deteriorated states. 



To sum up: ]\Iild psychoneurotic symptoms, such as apathy, feeling 

 of inaptitude for work and moodiness occur in a very large number of 

 cases of acromegaly after the disease has become well established. A fur- 

 ther evolution into psychoses of the manic-depressive type, with prepon- 

 derance of the depressive phase, takes place in a limited number of cases. 

 Rather than ascribe them to hypothetical hypophyseal, thyroid and adrenal 

 influences, or to worry over disfigurement of the features, we remain on 

 safer ground if we connect these psychic ills with the precocious sexual in- 

 volution which is known to be a feature of acromegaly in both sexes. It 

 is significant that the prevailing climacteric psychoses are very similar in 



