Case with hypertrophy of the pitui tary body and persistence of the thymus; the thyroid gland was enlarged and weighed nearly two ounces. T. Coke Squance (Brit. Med. Jour., Nov. 4, '93).
The thyroid gland was examined in 24 cases; it was normal in only 5 and hypertrophied in more than half. The thymus was examined in 17 cases; it was absent in 7, hypertrophied in 3, and persistent in 7. The sympathetic gan glia were examined in 10 eases and re ported as hypertrophied in 6. The only constant associated changes appeared to be those in the pituitary body; these changes were not uniform and might occur without acromegaly. Percy Fur nivall (Lancet, Nov. 6, '97).
The spleen and the lymphatic glands are generally sclerosed.
Among the various theories as to path ogenesis of acromegaly the following are the most prominent:— Aeromegaly is due to an unusual de velopment of the vascular system; it is a thymic angiomatosis. The endothelial elements originating in the thymus play the part of vasoformator cells, causing au increase in the vessels, and hypernutri tion and increase in growth of the ex tremities where the blood-current is the slowest. (Blebs.) Case in which there was hypertrophy of the pituitary body compressing the optic nerves. persistence of the thymus, and hypertrophy of the great sympa thetic. Cepeda (Revista BaleRr de Cien cias Medicas, Jan. 15, '92).
Case in which the tumor of the pitui tary body was a typical spindle-celled neurosarcoma.
The thymus was of considerable size, but without any change in its elements: the thyroid gland was enlarged and filled with small cysts containing col loid matter. Mosse and Daunic (Soc. Anat., Paris. p. 633. Oct. 25. '95).
It is due to disturbances in the evolu tion of the genital life. (Freund, Ver straeten.) A trophoneurotic affection, due to changes in the central and peripheral nervous system, causing hypertrophy of the extremities by means of the vaso motor system. (Recklinghausen and Irolschewnikow.) A systematic dystrophy, something like myxcedema, and connected with some organ (pituitary body?) much as myxcedema is in connection with re moval or alteration of the thyroid gland.
(P. Marie.) The pituitary body has been destroyed in animals without causing acromegaly. (Marinesco, Vassale, Sacchi.) The cases described by Hagner, Fraent zel, and Gombanit-Marie must be Con sidered as a form standing between acromegaly and osteoarthropathy. The disease begins in youth, without being preceded by any affection of the lungs; the bones of the face and the cartilages are affected. and the pathological changes are more like those of aerome galy than of osteoarthropathy. F. R. Walters (Progros MOd.. No. 3, '96).
Three cases of acromegaly, in the first of which diabetes. gigantism, and 4planchnomegaly were present; in the second arteriosclerosis. and in the third dyspepsia and a lesion of the pituitary body (sarcoma. cysts) : but other quite different changes were likewise visible, namely: degeneration of the thyroid gland, periependymatous gliomatosis, and cancer of the viscera.
When the embryological and anatom ical relations of the ependyma and pitui tary body are considered, it may be asked whether they do not, as a whole, form an anatomical and physiological system governing the processes of nutri tion and capable. when diseased, of giv ing rise to the dystrophic changes of aeromegaly. Dallemagne (Arch. de Med. Exp., No. 7, '96).
Prognosis.—Progressive, slow, and in terrupted advance of the disease, lasting from twenty to thirty years, and ending in death either by cachexia, by some complication, or, very rarely, by sudden syncope represent, in brief, the course of the vast majority of cases.
Treatment.—At present it can be only symptomatic. The extracts of thyroid gland and pituitary body will probably prove useless as curative agents. Pain and insomnia are relieved by antipyrine, sulphonal, etc. Arsenic has proved use ful in some cases. Iron in large doses and hydrotherapy have done some good in one case in the hands of Brissaud, and ergot in those of Schwartz.
Case of acromegaly treated with desic cated thyroid gland with good results. Solomon Solis-Cohen (Med. and Surg. Reporter, May 26, '94).