894 



WALTEK TIMME 



life. Growth has continued until the patient is six feet tall or over; his 

 weakness, even though his musculature seem splendid, is his prominent 

 symptom. He shaves rarely or never. Pubic and axillary hair remain as 

 before. Now he begins to notice an enlargement of his hands and feet, 



and a frontal headache or, rather, an in- 

 tratemporal headache appears. Blood 

 pressure remains low (90 to 100 milli- 

 meters, systolic) ; blood sugar usually re- 

 mains low, but now frequently rises as 

 compensation progresses. The patient 

 shows decided vagotonic symptoms. An 

 x-ray of the skull at this stage, or during 

 this stage, if the case progresses favor- 

 ably, shows a sella turcica which, while 

 small, may show erosion of the clinoids 

 and a deepening of the cavity. This 

 tendency of the pituitary to become 

 hyperactive produces the headache (if 

 the sella is contracted), the increase in 

 blood sugar content, the growth of hands 

 and feet, and a gradually rising blood 

 pressure. Where the sella is roomy, the 

 headaches are usually absent. 



The fourth stage is entered from 

 three to ten years later. This is the 

 stage in which either complete compen- 

 sation is produced or else the untreated 

 case takes on the varying and various at- 

 tributes produced by an enlarged pitui- 

 tary body engrafted upon the earlier 

 manifestations of a thymic state. That 

 is, we have in the completely compen- 

 sated case features of acromegaly, al- 

 though the blood pressure and blood sugar 

 are normal and the headaches have gone. 

 The sella turcica on x-ray examination 

 seems large. In the uncompensated cases 

 we usually see a sella which is still small 

 and perhaps bridged, with headaches of 



increasing severity, perhaps attacks of petit or grand mal, dependent upon 

 the disturbance of pituitary function, mental torpor, increase of weight 

 with constantly increasing fatigue, and a final lethal termination due to 

 intercurrent disease. 



Fig. 1. Shows abnormal length 

 of thorax compared with legs. 

 Thighs especially short compared 

 with lower leg. Small genitals. Has 

 large thymus and enclosed sella. 

 Represents status thymicolymphat- 

 icus condition, from which springs 

 the syndrome. 



