Case of acromegaly in which the heart was enormously enlarged, weighing two pounds and nine ounces: one of the largest hearts on record. 0. T. Osborne (Med. News, May 22, '97).
Case of a man, 23 years of age, who was quite well until 1893, when he had an attack of typhoid fever, after which typical acromegaly developed, including pigmentation, except that there was no great enlargement of the lower jaw. He died, soon after admission, of diabetic coma. Necropsy showed, in addition to the usual external signs of acromegaly, a general enlargement of the viscera. Liver weighed 90 ounces, the spleen 9 V4 ounces, the heart 13, and the kidney 9. The pituitary body was so enlarged as to distend the sella Turcica, and contained several drops of a fluid resembling pus. It did not appear to have compressed the commissure, and there was no optic atrophy. Norman Dalton (Lancet, May 22, '97).
The pigmentation noticed in the above ease might have been due to the condition of the thyroid, the association of acrome galy with exophthalmic goitre being a recognized one; the disease had obscure relations with myxmdema, and had been successfully treated by means of thyroid extract, although the work of Schafer and Oliver had shown that extracts of thyroid and of pituitary body were an tagonistic in action. H. D. Rolleston (Brit. Med. Jour., May 22, '97).
The skin of the extremities shows hyperplasia of the papillae, and hyper trophy of the derma, all the connective tissue system being enlarged, that of sweat-glands, sebaceous glands, hair follicles, external and internal vascular walls, and, above all, the lamellated sheath of the infradermic nerves are likewise degenerated.
There is marked sclerosis of the great sympathetic system, especially the lower cervical ganglion. The neuroglia in the brain is hyperplastic.
Autopsy showing following conditions: The lymphatic ganglia of the neck pro foundly altered, containing no more lymph-follicles; all varieties of white globules present, with single nucleus, with polymorphous nucleus, and with multiple nuclei. The striated muscular tissue of the neck showed atrophy and sclerosis, the nuclei had budded abun dantly, and the sarcoplasma had under gone vacuolar and granular fatty de generation. The hypertrophied pituitary
gland was undergoing process of necrosis, and liquefaction of its constituent parts had taken place: the portions escaping this destruction consisted of lymphoid tissue similar to that of the lymphoid ganglia of the neck. The thyroid gland was affected both by atrophy and gland ular hypertrophy, as well as by hyper trophy of the connective tissue and lymphoid infiltration.
The liver showed fatty degeneration and glandular atrophy, with slight lymphoid infiltration of the interlobular connective tissue. There was chronic interstitial and parenchymatous inflam mation of the kidneys, hyperplasia of the splenic pulp and of the Malpighian follicles. The tongue was increased in size from hyperplasia of its connective tissue. Claus and Van der Stricht (An nales de la Soc. de Med. de Gand, No. 71, '93).
The blood does not show evidence of great alteration.
In one case the amount of haemoglobin was 95 per cent. of the normal; the average of ninety-six countings showed 7,000,000 red corpuscles to the cubic millimetre. The proportion of white to red corpuscles was about 1 to 400. Church and llessert (Med. Record, May 6, '03).
The kidneys show chronic parenchy matous nephritis in the cortical sub stance, moderate sclerosis of interstitial tissue, and peripheral infarcts.
In the thyroid gland the follicles are either found hyperplastic or cystic, and contain haemoglobin crystals. This organ is generally hypertrophied. The thymus is occasionally found to have persisted.
Case showing a large glioma of the hypophysis, and each lobe of the thy roid enlarged and containing a cyst. Bury (Med. Chron., July, '91).
Typical case, which appeared to date from an old cerebral affection, in which hypertrophy of the thyroid gland was also observed. Bruzzi (Gaz. degli Osp., Aug. 4, '92).
Case of diabetic acromegaly, with thick and heavy skull, and an occipito frontal diameter of sixty-six centime tres. The pituitary body was softened and voluminous; the thymus had per sisted, and the thyroid body was cre taceous. Lathuray (Lyon Bled., July 11, '93).