ACROMEGALY 851 



eunuchoidism, and in one member, features of muscular dystrophy. Fur- 

 ther interest is lent to this familiar group by Janeway's observation that a 

 familial tendency existed in several of the reported "primary" cases of 

 osteoarthropathy. 



Ostitis Deformans. Paget's disease also causes bony enlargement 

 and deformity, but of a different type. The cranial part of the skull is 

 thickened rather than the facial, and the bones of the arms, forearms, 

 thighs and leg are affected instead of the hands and feet. The excessive 

 curving of the long bones seen in ostitis deformans does not occur in 

 acromegaly while kyphosis is common in both. Enlargement of soft parts 

 is not a feature of ostitis. The bony enlargements of acromegaly are 

 usually symmetrical, those of ostitis often very asymmetrical. The onset 

 in ostitis is usually at much later age, after fifty years. 



Hemihypertrophy (see section on Gigantism) is sometimes wrongly 

 designated "unilateral acromegaly." It is congenital, involves the whole 

 lateral half of the body and should not offer any diagnostic difficulty. 



Syringomyelia. This condition may be associated with arthropathies, 

 and hypertrophies of bone and soft parts, especially of the hands, but the 

 presence of dissociated sensory disturbance, muscular atrophy and altered 

 reflexes and absence of the acromegalic facies usually quickly settle the 

 question. We cannot subscribe to Vincent's statement that syringomyelia 

 may give rise to the typical clinical and anatomical findings of acromegaly. 



Exophthalmic Goiter. At first thought exopthalmic goiter will not be 

 considered a possible source of error as there is a tendency to increased 

 delicacy and slenderness, especially of the fingers, rather than to enlarge- 

 ment. However, in early acromegaly the sweating, exhaustibility, and fre- 

 quent exophthalmos and thyroid enlargement have occasionally led to an 

 erroneous diagnosis of Graves' disease. Impairment of vision is not a 

 feature of the latter, and tremor and tachycardia are uncommon in 

 acromegaly. 



Myxedema. Difficulty in diagnosis may be encountered in an early 

 case of myxedema. There is no bony enlargement, particularly no prog- 

 nathism, and the skin, while thick, is smooth and of a different appearance 

 from the rough, wrinkled, redundant skin in acromegaly. 



Prognosis 



With the exception of the transient and incomplete acromegaly some- 

 times observed in pregnancy the condition is a permanent and indelible 

 one. However, as has been pointed out, the active process may cease at 

 any stage and the condition remain stationary without any material dis- 

 comfort and shortening of life. Remission lasting for many years may 

 also occur. Acceleration of the disease may follow pregnancy, trauma, or 



