. The endocrine organs; an introduction to the study of internal secretion . B c D FIG. 74.—Four photographs of the same person showing the gradual development of thefacial appearance characteristic of the acromegalic. (Gushing.) A, at 24 years of age (prior to the commencement of the disease) ; B, at 29 (onset of disease); C, at 37 ; D, at 42 years of age. limbs and head. The hands (fig. 75), feet, and face are especially hyper-trophied, and X-ray photographs show a typical mushrooming of the ungual 108 phalanges (fig. 76). The Endocrine Organs. FIG. 75.—Typical hand of acrome-galic. (Gushing
. The endocrine organs; an introduction to the study of internal secretion . B c D FIG. 74.—Four photographs of the same person showing the gradual development of thefacial appearance characteristic of the acromegalic. (Gushing.) A, at 24 years of age (prior to the commencement of the disease) ; B, at 29 (onset of disease); C, at 37 ; D, at 42 years of age. limbs and head. The hands (fig. 75), feet, and face are especially hyper-trophied, and X-ray photographs show a typical mushrooming of the ungual 108 phalanges (fig. 76). The Endocrine Organs. FIG. 75.—Typical hand of acrome-galic. (Gushing.) Notice thebroad palm and digits and therelatively small nails, which lacklunulee. But the enlargement is not confined to the bones ofthe extremities; it affects the whole skeleton,which becomes thickened and is often considerable muscular develop-ment ; the subject being abnormally the affection does not supervene until adultlife is attained, until the epiphysial carti-lages are ossified, the long bones do not growin length and the height is but little affected,any increase of stature that is produced byincrease of the vertebral column being usuallymore than compensated for by a kyphosis(fig. 73), which supervenes after the diseasehas made some progress. But if the hyper-pituitarism commences whilst the cartilagesare still unossified, there is a considerablegrowth in length of the long bones, so thatthe patient attains an unusual height. This condition is known as pituita/ry gigantism1 (fig. 77); it
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