238 ACROMEGALIA 



of many acromegalics. In other organs, as in the heart and the spleen, 

 pathologic enlargements occur, yet they must not be looked upon as conse- 

 quences of the acromegalic process, but as independent diseases. 



Corresponding to the clinical symptoms, the frequently determined hyper- 

 plasias or degenerations of the internal female genitalia and of the testicles 

 are perhaps in intimate relation to the pathologic process, while the cutaneous 

 parts of the external genitalia are frequently implicated in the acromegalic 

 enlargements. 



In the pancreas, connective tissue hyperplasia has been described several 

 times. On account of the frequent complication of acromegalia with dia- 

 betes, we might easily interpret this as a result of the acromegalic process. 

 But in the cases investigated by me, particularly in the one combined with 

 diabetes, the pancreas was perfectly normal, while, in another case in which 

 connective tissue increase was present, diabetes did not exist. 



The central nervous system, i. e., the base of the brain, may be involved 

 directly and to a marked extent by the tumor of the hypophysis, particularly 

 the infundibular region, the pons, and the optic chiasm. All other findings, 

 such as column degeneration of the spinal cord, represent only accidental 

 complications. In the cervical sympathetic, Marie and Marinescu found con- 

 nective tissue increase and ganglion degeneration, and this was several times 

 confirmed by other observers. In my cases I was unable to recognize decided 

 changes in this region. 



The chief interest of pathological researches has been concentrated for a 

 long time upon the so-called " blood-vessel glands." Of these the thymus 

 gland first attracted attention for a short time after Klebs had ascribed to 

 it a predominant role in the disease. The enlargement of the thymus gland 

 is, in fact, a very frequent finding. The gland may extend into the anterior 

 mediastinum, so as to correspond with that of the new-born, though in com- 

 parison it is actually larger. The adrenals are large but normal. The thy- 

 reoid gland may develop into a massive goiter, or may be decidedly atrophic. 

 The enlargement may be of any of the types usually found in goiters, without 

 any predominant specific form being recognizable. The degenerative forms evi- 

 dently have nothing in common with those characteristic of myxedema. In my 

 case the glomus carotideum was examined, and found to be small and normal. 



In the pathology of acromegalia our greatest interest is in the hypophysis. 

 Since the first undoubted autopsy findings of Verga in a case of acromegalia, 

 the characteristic findings in the skeleton by v. Langer, and the observation 

 of tumors of the mucous gland (pituitary body), the autopsies in acromegalia 

 have been more numerous. In accordance with the size and character of the 

 tumor, the description of the findings varies. There are extant descriptions 

 of the pituitary gland which show that the authors did not consider this to be 

 at all enlarged, and we can only base our assumption of an enlargement upon 

 the fact that masses were mentioned as present. In other cases the enlarge- 

 ments are distinct, but only of moderate degree. Thus, in two cases, I have 

 found tumors about the size of a cherry, one of which eroded the groove of 

 the pituitary body and the other the dorsum sellse. The enlargements are of 

 every degree up to the size of a goose's egg or even an apple. These either 



