THE PITUITARY 375 



of the pituitary body furnishes an abnormal, an excessive, 

 quantity of some hormone which stimulates bone growth, 

 and that, in consequence, the growth of bone itself becomes 

 excessive. 



The cases referred to above in which after death the sub- 

 stance of the pituitary has been completely destroyed and 

 replaced by a malignant growth, would seem to present a 

 certain difficulty in the way of acceptance of the hypersecretion 

 theory. They would seem, in fact, to furnish important 

 evidence that the symptoms of acromegaly have been brought 

 about as the result of the suppression of an internal secre- 

 tion. But, of course, it is possible to assume that the 

 tumour at its beginning was non-malignant, and that the 

 malignant character has become developed shortly before 

 death, and that death has resulted from entire suppression of 

 the function of the gland, owing to destruction of the normal 

 glandular cells by those of a malignant nature ; for it appears 

 possible that complete destruction of the gland is incompatible 

 with continuance of life. 



Since, after destructive disease of the reproductive organs, 

 the pituitary is found to be enlarged, it has been suggested 

 that the actual commencement of the mischief in acromegaly 

 may be in the ovary or the testis. 



The pathogeny of acromegaly thus appears to be analogous 

 to that of exophthalmic goitre, the first being due to a hyper- 

 function of the pituitary, the second to a hyperfunction of the 

 thyroid gland. 



Yamada has recently reported a case in which there were 

 clear symptoms of acromegaly with a normal pituitary, but the 

 thyroid was enlarged, the thymus was persistent, the testes 

 atrophic, the pineal contained masses of colloid, and there was 

 hypertrophy of adrenal medulla. The case was therefore 

 characterized as " poly glandular." We must bear in mind the 

 recent experiments of Camus and Roussy (see above, p. 365). 



(7) Course and Event of the Disease Diagnosis, Prognosis, 

 and Treatment 



The disease runs a slow and prolonged course, and goes on 

 to a fatal issue. 



The diagnosis is usually a matter of no great difficulty. 



