. A text-book of medicine for students and practitioners . characteristicaspect to acromegaly. Thehyperplasia of the lower jawmay reach so high a degreethat the individual teeth areseparated. In the hands andfeet, the fingers and toes, andespecially their terminal pha-langes, become thicker andwider, so that we may speakof actual paws. The hyper-plasia not only affects thebones, but it makes the skinthick and wrinkled. A mani-fest kyphosis of the spineusually develops. Other note-worthy symptoms sometimesoccur. Thus, we sometimessee marked glycosuria, an in-creased secretion of sweat, andparti
. A text-book of medicine for students and practitioners . characteristicaspect to acromegaly. Thehyperplasia of the lower jawmay reach so high a degreethat the individual teeth areseparated. In the hands andfeet, the fingers and toes, andespecially their terminal pha-langes, become thicker andwider, so that we may speakof actual paws. The hyper-plasia not only affects thebones, but it makes the skinthick and wrinkled. A mani-fest kyphosis of the spineusually develops. Other note-worthy symptoms sometimesoccur. Thus, we sometimessee marked glycosuria, an in-creased secretion of sweat, andparticularly disturbances ofvision, either hemianopsia [es-pecially bitemporal hemianop-sia.—K.] or amblyopia from atrophy of the optic nerves. These disturltancesof vision are connected with the noteworthy fact that in most cases of acro-megaly a tumor of the hypophysis cerebii develops, which ))resses directly onthe nerves of the optic tract. A patient under our observation (Fig. 212)died with symptoms of a tumor at the base of the brain, and the autopsy. Fig. 212.—Acromegaly in a patient thirty years old.(Personal observation.) 568 DISEASES OF THE NERVOUS SYSTEM showed a sarcomatous tumor of the hypopliysis which had grown through theadjacent bony parts. The diagnosis of acromegaly is not difficult. We must merely guardagainst confusing it with other conditions also leading to thickening of thebones (partial giant growth, arthritis and osteitis (hlonnans, diffuse and local-ized hyperostoses, etc.). The so-iiilled liypertro])hic osteoarthropathy is alsoto be distinguished from acromegaly. This affection is seen especially inpatients with chronic bronchitis, lironchiectasis, chronic tuberculosis, etc., andit also leads to a paw-like thickening of the fingers, but the changes in tiielower jaw so very characteristic of acromegaly are absent, and also the othernervous symiiloms, especially those of tumor of the hypophysis. The treatment of acromegaly is, unfortunately, almost whol
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