MTLTIGLANDULAK SYNDROMES 903 



to a stop a self-curative process. It is analogous to the hypertrophied 

 heart, become so through the deficiency of the cardiac valves and making 

 up for such deficiency by its enlargement. And that condition likewise, 

 per se, needs no treatment. A case that presents acromegalic features, 

 therefore, need not necessarily be a case that calls for therapeutic inter- 

 vention. It may well be a "finished" case. W. W. (Fig. 9) is a good 

 representative of this type. In these "finished" cases the patients must 

 always, however, live within certain limits of exertion and stress. The 



Fig. 11. Uncompensated case. Shows pituitary fossa completely enclosed. Stereo- 

 scopic plates confirm this. Girl, age twenty-two years; height 6 feet. Inability to 

 walk a short distance; headaches severe. Low blood sugar; systolic blood pressure 90. 



cases that in the fourth stage do not spontaneously go to full compensation 

 are those in which we either find a sella turcica which did not enlarge 

 (perhaps because there was no spontaneous effort of the pituitary to become 

 hyperactive) or in which an enlargement of the sella did take place and, 

 the pituitary even in its hyperactive condition was not sufficient to com- 

 pensate. These uncompensated cases go right on with progressive symp- 

 toms of fatiguability, asthenia, headaches, and so forth, making them easy 

 prey to intercurrent affections. 



Treatment. The treatment of these cases in any stage is, in the 

 writer's experience, satisfactory. The great point to remember is the 

 probable nature of the process of compensation which the organism is 

 endeavoring to carry out, That would make one believe that suprarenal 

 gland therapy is indicated throughout on account of the patent deficiency 

 of this organ in these cases. And yet in our hands administration of 

 suprarenal products is often disappointing. The whole gland perhaps has 



