. Atlas of clinical surgery; with special reference to diagnosis and treatment for practitioners and students. of the face. It generally appears betweenthe twentieth and fortieth years and may remainstationary. In many cases there is, first of all,hypertrophy of the bones of the hands, feet and face. The disease has been attributed to changes in thepituitary body (hypertrophy, adenoma, sarcoma,cyst); to changes in the thyroid gland, pancreas,genital glands; to persistence of the thymus; tonervous influence, since nervous disorders have beenobserved in the hypertrophied extremities; also toa co
. Atlas of clinical surgery; with special reference to diagnosis and treatment for practitioners and students. of the face. It generally appears betweenthe twentieth and fortieth years and may remainstationary. In many cases there is, first of all,hypertrophy of the bones of the hands, feet and face. The disease has been attributed to changes in thepituitary body (hypertrophy, adenoma, sarcoma,cyst); to changes in the thyroid gland, pancreas,genital glands; to persistence of the thymus; tonervous influence, since nervous disorders have beenobserved in the hypertrophied extremities; also toa congenital condition. The most probable of theseis enlargement of the pituitary body, which can bedemonstrated by widening of the sella turcica, shownby the X-rays. Large tumors of the pituitary bodymay press on the optic nerve and nerves of theocular muscles. The prognosis is not unfavorable, as severe dis-turbances only occur after the disease has existedfor many years. Differential Diagnosis. Partial giantism, whichalso begins in the hands and feet, differs from acro- 410 Bockeiiheimer, Atlas. Tab. Fiu. IJO. Akiomeyalia — Alakroniclia A\akroglossia. Rebiiian Comnanv. NeT-Nork megaly by being congenital. In ieontiasis ossea thereis enlargement of the bones, while the soft parts aremore often atrophied. Acromegaly affecting one ex-tremity only might be mistaken for osteitis deformans,or for chronic osteomyelitis, as there may be length-ening of the bone in both these diseases. Acro-megaly differs from elephantiasis in the presence ofenlargement of the bones, which can be shown bythe X-rays. Acromegaly commencing in the facemight possibly be mistaken for tumor of the uppermaxilla, but there is usually early hypertrophy of thecheeks (macromelia), lips and tongue (macroglossia),and of the hands and feet. Treatment. Thyroid extract and extract ofpituitary gland have been recommended. Tumorof the pituitary gland may be removed by enlargement of the soft pa
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