Virchow (Berliner klin. Woch., Dec. 16, '95).
llyperplasia of the connective tissue and adipose tissue of the periosteum is present, while its inner layer gives rise to osseous neoformation.
There is central absorption due to ostcoblasts, with intense peripheral his togenesis, in the periosteum and articu lar cartilage. (Marie and Marinesco.) The lesion most frequently observed, and apparently the main feature of the disease, is one of the pituitary body. This organ may undergo various patho logical changes, ranging from hyper trophy to the more malignant forms of neoplasm, such as sarcoma.
Of 19 published cases there was hyper trophy of hypophysis in 3, hypertrophy with increase of connective tissue in 1, sarcoma in 3, adenoma in 2, softened ade noma in 1, tumor with little cavities lined with epithelium in 1, glioma in 1, tumor with character not specified in 3, vascular hypertrophy in 1, colloid degen eration in 1, sclerosis and atrophy in 1, and necrosis with softening in 1. Stern berg (Zeit. f. klin. Med., vol. xxvii, p. 86, '95).
Enough cases have been reported to refute the hypothesis that the enlarge ment of the hypophysis eerebri in acro megaly is, like the other hypertrophies, merely a symptom of the disease. If simple hypertrophy were the constant lesion, it might be claimed that it was a result and not a cause of the disease, but it hardly needs argument to show the improbability that any one disease would cause, in a single organ, so many and various morbid conditions as are enumerated in Sternberg's list. W. L. Worcester (Boston Med. and Smug. Jour., Apr. 23, '96).
Analysis of thirty-four recorded ne cropsies on cases of acromegaly. Changes in the pituitary gland found in all. In all but three there had been either hy pertrophy or tumor. Percy Furnivall (Lancet, Nov. 6, '97).
Of 97 reported cases of acromegaly, autopsy had in 15 cases: 12 showed changes in the hypophysis cerebri. There is a connection bete eon the changes in the pituitary body and acromegaly. Per sonal view that all organs have a double function: a negative, withdrawing some thing from the organism; and a positive, introducing something into the organism.
The progressive development of one or gan has progressive development of other organs as a consequence. llansermann (Berliner klin. Woch., May 17, '97).
Case of acromegaly in which death occurred in an accident. At necropsy the skull was found uniformly thickened and heavy, and all the air-spaces were dilated. The sella Turcica was deep and wide, and the pituitary body was con verted into a cyst containing semifluid substance. Percy Furnivall (Lancet, Nov. 6, '97).
(1) Cases of acromegaly associated with true tumor of the hypophysis are certainly not so numerous as has been heretofore supposed; (2) there is not as much constancy in the pathological con dition of the hypophysis as there is in the enlargement of the heart, the thyroid gland, or the sella Turcica; (3) acro megaly does not depend, at least not solely, upon abolition of any function of the hypophysis; (4) a relationship be tween the thyroid gland and the hypoph ysis has already been amply proved; (5) it is not at all improbable that pro liferation of the histological elements of the hypophysis may be instituted in some cases by primary enlargement of the sella Turcica; in other cases an cedema or haemorrhage ex vacuo; (6) we have no reason for supposing that en largement of time sella Turcica must be as constant an occurrence in acromegaly as the changes in other bones, or that it might not take place from the same cause or causes. Mitchell and Lecount (N. Y. Med. Jour., Apr. 29, '99).
Necropsy of a case in a man who died at the age of 70 and which had the typ ical characters of the malady. The pitu itary body was three times its usual size: the thymus was looked for in vain; and the thyroid body was goitrous fibrocystic, the two lobes—but especially the right— being much enlarged. The heart was large, without valvular lesions; so was the great sympathetic; but the diameter of the large blood-vessels was not sensi bly increased. Microscopically the pitu itary body showed in places small colloid masses, a very marked dilatation of the vessels, and hypertrophy of the cells. Pagniez (Bull. et Mem. Soc. Anat. de Paris, S. 6, vol. i, p. 942, 1900).