HYPOPHYSIS CEREBRI 337 



with typical acromegaly ; the promptness and the success of his 

 results were literally startling. Five days after operation, the acute 

 headache and periodic disturbances of vision had disappeared, 

 and the teeth in the upper jaw had closed up ; from the eighth 

 day, the hands and feet became noticeably smaller ; at the end of 

 three months, with the exception of insignificant traces of thicken- 

 ing of the soft parts, the involution of the acra was complete. 

 Menstruation reappeared and became regular. At the end of 

 six months, the acromegalous symptoms had entirely disappeared, 

 but the patient had an enlargement of the thyroid gland. Histo- 

 logical examination of the extirpated tumour showed it to be a 

 malignant adenoma and quite free from typical chromophile cells. 



Another case, that of partial recovery from acromegaly, is 

 described by Gushing (1909). He performed partial hypo- 

 physectomy of the hypertrophied anterior lobe. The symptoms 

 of intercranial pressure did not entirely disappear, but there was 

 an appreciable reduction of the acral parts. 



A second case of acromegaly was successfully treated in 

 Hochenegg's clinic and is described by A. Exner. The patient 

 was a woman, aged 37 ; seven years previously 'the menses ceased 

 and the power of vision became progressively reduced ; increased 

 growth of the acral parts had been noticed for four years, 

 and abnormal growth of hair for three. At the time of operation, 

 the symptoms of typical acromegaly were well developed, and a 

 tumour the size of a walnut was removed from the hypophysis. 

 After operation, the headache, which had previously been very 

 violent, ceased ; the skin of the hands and feet became thinner ; 

 the circumference of the fingers became smaller; the bristly 

 moustache hairs fell out; the teeth closed up; and the tongue 

 became reduced in size. In this case also, the 'thyroid developed 

 a middle lobe which could be distinctly felt upon palpation. In 

 this case, as in the first, the tumour was a malignant adenoma 

 (Wurmbrand). 



The therapeutic results of hypophysis extirpation in acrome- 

 galy supply the last conclusive link in the chain of evidence in 

 favour of the theory, that the causative factor in acromegaly is 

 to be sought in hypersecretion of the hypophysis. Such being 

 the state of things, it is not surprising that, in those cases where 

 hyposecretion was assumed and the condition was treated by 

 organo-therapeutic methods with pituitary substance, the specific 

 acromegalic symptoms remained unchanged. In those rare in- 

 stances where benefit has been derived from the use of pituitary 

 substance, the subjective symptoms, especially the headache, were 

 affected, while the developmental changes were entirely unaltered. 



If we regard acromegaly as a manifestation of hyperpituitar- 

 ism, the question arises as to why spontaneous recovery does not 

 take place in cases where there is malignant degeneration of the 

 hypophysal tumour and where, from the nature of the histological 



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