THE PITUITARY 373 



are frequent. Somnolence is often marked, and may pass 

 into stupor. The urine is normal or there may be glyco- 

 suria (Dock). 



(3) Etiology and Onset 



Acromegaly has been sometimes ascribed to syphilis, or some 

 other specific infection. Heredity has also been claimed as 

 having some part in the causation. There is, however, no 

 sufficient evidence that any of these bear any essential relation 

 to the disease. 



The disease occurs, perhaps, most frequently in early adult 

 life, between the age of puberty and the thirtieth year. It is 

 more common in women than in men. The onset is gradual. 



(4) Metabolism in Acromegaly 



If acromegaly be, in fact, due to a hyper secretion of the 

 pituitary body, we should naturally expect that in this disease 

 the metabolism would be modified in the same direction as in 

 animals fed upon pituitary substance. The few experiments 

 which have been performed upon acromegalic patients have 

 given contrary results. Retention of phosphates in the bones 

 and muscles and increase of urinary calcium have been alleged. 



(5) Morbid Anatomy 



The bones appear to undergo a true hypertrophy in the 

 majority of cases, though it is stated that the superior maxillary 

 appears to be larger on account of a simple dilatation of the 

 antrum. In the long bones the enlargement affects the ends 

 as well as the shaft. 



The view which has the greatest number of adherents at the 

 present time is that the characteristic lesion in acromegaly is 

 adenoma of the pituitary. This belief was first definitely put 

 forward by Benda. Previously the tumour had been known 

 by various names, perhaps most frequently as a "round- 

 celled sarcoma." Hanau had previously suggested that the 

 typical growth is an adenoma ; and Lowenstein has given 

 a lucid account of the development of this adenomatous 

 tumour. 



Other tumours of the pituitary do not appear to give rise 

 to acromegaly. Thus, Pende states that tumours of the 

 " pharyngeal pituitary " (remains of the pituitary duct) never 



