. Acromegaly . pear. The floor of the sella Turcica is bulged downwards,so that the sphenoidal sinuses are much diminished in size:at the same time it becomes like paper, and is often perforatedin several places. If the tumour grows more markedlydownwards, the thin plate of bone, which separates thepituitary fossa from the sphenoidal sinuses, becomes quiteconsumed. In most cases then the surrounding walls of bonegive way on all sides to the pressure of the tumour and thebone is everywhere destroyed, something similar to the ster-num and ribs before a forward- growing aortic aneurysm. Itmay als
. Acromegaly . pear. The floor of the sella Turcica is bulged downwards,so that the sphenoidal sinuses are much diminished in size:at the same time it becomes like paper, and is often perforatedin several places. If the tumour grows more markedlydownwards, the thin plate of bone, which separates thepituitary fossa from the sphenoidal sinuses, becomes quiteconsumed. In most cases then the surrounding walls of bonegive way on all sides to the pressure of the tumour and thebone is everywhere destroyed, something similar to the ster-num and ribs before a forward- growing aortic aneurysm. Itmay also attack the pharyngeal wall of the sphenoidalsinuses, so that of the whole body of the sphenoid only smallthin trabeculse of bone remain, which surround the fusedpituitary fossa and sphenoidal sinuses. A similar conditionis found if the tumour of the hypophysis directly infiltratesthe bone. The growth then proceeds quite irregularly, thesphenoid is destroj^ed in the mqst varied manner, partly by ACROMEGALY. 25. Fig. 8.—rU-year-old man with acromegaly (same as in Fig. 2) 26 ACEOMEGALY. direct encroaclimeiit, partly tlirougli secondary growths indifferent places. The ujjper surface of the sphenoid seldom supports trueosteophytes: Brigidi has described two abnormally pointedand long clinoid processes (medii?). The body of thesphenoid also has no share in the hyperostosis: the canaliscraniopharyngeus lateralis discovered by me,* which in thegeneral hyperostotic skulls usually disappears without atrace, remains frequently in acromegaly partly pterygoid processes are, on the contrary—as muscularattachments—hj-pertrophied and rough. The vertebral column in advanced cases shows a kyphoticcurve in the upper dorsal and lower cervical region, which iscompensated for by a suitable lumbar lordosis. Lateral curva-tures may also be present. The kyphosis is in many cases basedon the shape of the vertebral bodies (Broca, Sternberg), sincethese are lower in front than behind
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