Acromegaly Following Gigantism: Report of Case Treated by X-ray

Abstract

ACROMEGALY was first accurately described, and was named, by Marie in 1886. It is a condition occurring in adult life, characterized by enlargement of the “acra,” i. e., the hands, feet, lower jaw, nose and lips. Typically, the skeletal changes consist in enlargement, with tufting, of the terminal phalanges of the fingers and toes, enlargement of the bones, as well as the soft tissues, of the hands and feet, overgrowth of the inferior maxilla with progressive malocclusion of the teeth, and increasing prominence of the frontal region, with great enlargement of the frontal sinuses. It is stated (Bassoe) that the bone changes are secondary to changes in the soft parts, and are, indeed, caused by these soft-tissue changes. Cushing gives four views as to the causation of acromegaly. The first is Marie's conception of it as a general dystrophy, although he later believed it to be caused by a diminished hypophyseal function. The second is that it is due to an eosinophilic hyperplasia of the pituitary, with or without enlargement, producing hyperfunction. This is the view of Benda, Lewis and Erdheim. The third conception is that the changes are due to an underlying nutritional disorder, the hypophyseal enlargement being secondary and not primary. The fourth view is similar to the third, in that it assumes the hypophyseal changes, when present, to be only an accidental finding, without true relationship to the disease. It is apparently accepted by most recent writers on the subject that the disease is invariably characterized by a period of hyperfunction of the pituitary, and that this period is an essential factor in the mechanism of the changes produced, whether it be the primary, or the only, factor, or not. Gigantism is, as its name implies, a symmetrical sort of giant growth, in which both bones and soft tissues attain more than the normal size for the age, though the character of growth remains normal, and without deformity. Like acromegaly, gigantism is caused, or at least partially caused, by hyperfunction of the anterior lobe of the pituitary gland. Unlike acromegaly, gigantism is a disease of adolescence, of the period prior to the union of the epiphyses. Apparently the same process occurring in an adolescent, which causes acromegaly in the adult, produces gigantism. It, then, apparently follows that if the morbid process continues active after epiphyseal ossification occurs, the disease will take on the character of acromegaly, following the gigantism which non-union of the epiphyses permitted to occur first. If the process begins in adult life, the changes will be purely acromegalic; while if the stage of hyperfunction begins and ends prior to epiphyseal union, the condition will be pure gigantism. In any event, the stage of hyperfunction is apparently always followed by a period of hypofunction.