THE PITUITARY 371 



tion, in which there is markedly slowed metabolism and in which 

 histological changes in the pituitary body have been described. 



There is a tendency for pituitary diseases to lapse into a 

 condition where glandular insufficiency is the most noticeable 

 feature, and this is especially the case with disorders of the 

 anterior lobe. 



Gushing divides symptoms of pituitary disorder into three 

 main groups : 



1. Endosecretory symptoms on the side of hyperpituitarism. 



2. Endosecretory symptoms on the side of hypopituitarism. 



3. Endosecretory symptoms of a polyglandular character. 

 As one might expect, many and very complicated systems 



of classification have been attempted. 



2. Acromegaly 



(1) Introductory 



The disease, which is characterized by enlargement of certain 

 bones of the body, especially of the hands and feet, was first 

 described by Marie, of Paris, in 1886. It was observed by 

 Marie that the disease is associated with tumours of the 

 pituitary body. It had, however, been described previously 

 under other names, as " hyperostosis of the entire skeleton " 

 by Friedreich, as "general hypertrophy " or " makrosomie " 

 by Lombroso, as " giant growth " by Fritsche and Klebs. 



(2) Symptoms 



There is usually a history of definite symptoms before the 

 characteristic deformities occur. Headache, pains in other parts, 

 irritable temper, moroseness, loss of memory, disturbances of 

 vision, increased appetite, thirst, and polyuria are enumerated 

 among the early symptoms. In women amenorrhcea is fre- 

 quently noted, while in men there may be loss of sexual power. 



The head increases in size, the brows become arched and 

 prominent, the forehead retreating. The nose is large. The 

 zygoma and malar prominences are exaggerated. The upper 

 jaw is not much altered, but the lower is distinctly enlarged 

 (Fig. 98). The lower teeth may project beyond the upper. 

 The chin is thick and the face may be oval or square. The 

 tongue becomes enlarged and may force the mouth open and 

 plays a part in the deformity of the alveolar processes. It is 

 usually indented at the sides and the papillae are enlarged. 



