848 PETER BASSOE 



own case I, which he claims was the first authentic instance of coexistance 

 of the two diseases, is open to criticism in regard to both diseases. Acro- 

 megaly carftiot be considered proven, as necropsy showed no hypophyseal 

 changes and the facial bones were not characteristic. The huge hands and 

 feet are partly explained by an existing family tendency to such enlarge- 

 ment, and the presence of an old tuberculosis of the pericardium, tracheo- 

 bronchial glands, and right lung may have led to a secondary hyperplastic 

 ostitis (Marie's osteoarthropathie liypertropliiante pneumique). The 

 syringomyelia is also doubtful as there was no glia increase, merely epithe- 

 lial proliferation about the central canal and sclerosis of the neighboring 

 vessels. A case presenting typical clinical and anatomic features of both 

 diseases is that of Bassi, and we are also quite safe in including that of E. 

 Schultz where the acromegaly was complete clinically and anatomically, 

 and the histologic changes in the cord were characteristic of syringomye- 

 lia, but there had been no symptoms of the latter except atrophy of some 

 muscles about the. shoulder. At all events, the simultaneous occurrence of 

 these two diseases is too rare to be anything more than mere coinci- 

 dence. 



That the much more frequent disease, tabes, should occasionally coin- 

 cide with acromegaly as in the case of de Castro, is not surprising. Tabes 

 also was present in Levi and Franchini's acromegalic giant (see chapter 

 on Gigantism). There is, however, no reason to suspect that acquired 

 svphilis causes or influences the hypophyseal disease, or that the existence 

 of acromegaly predisposes a syphilitic to tabes. In this connection it is 

 interesting to recall that hypophyseal tumor without acromegalic signs 

 has not infrequently been mistaken for tabes. This has been emphasized 

 by Oppenheim(&) (1914). A case in a woman with optic atrophy, loss of 

 tendon reflexes, shooting pains in the legs, and attacks of abdominal pain 

 resembling gastric crises, where necropsy revealed an Erdheim tumor of 

 the hypophysis, has been reported recently by Kaulston. But also in 

 typical acromegaly, as pointed out by Oppenheim, this a pseudotabes pitu- 

 itaria" may exist, evidenced by shooting pains and loss of reflexes, but 

 the characteristic growth disorder here prevents an error in diagnosis. 

 Such a case is reported by Nonne(a) in which also the pupils were small 

 and sluggish to light, yet all these symptoms were ascribed to non-tabetic 

 unsystematized cord degeneration. 



Differential Diagnosis 



Hypertrophic Pulmonary Osteoarthropathy. This is the one condi- 

 tion for which acromegaly is most likely to be mistaken. It was described 

 and named by Marie in 1890, partly on the basis of cases which he himself 

 had included in his first description of acromegaly. As the name implies, 



