Acromegaly: A Consideration of Its Course and Treatment Report of Four Cases with Autopsies

Abstract

The histories of 4 acromegalics who were followed for an extended period of time and who finally came to autopsy, are reviewed. The authors, dissatisfied with the therapeutic results achieved, are convinced that the treatment of the endocrinological aspects of this disease, in distinction from the neurological aspects, is being greatly neglected. The degree of activity of the acromegalic process is difficult to evaluate in a given patient at any given time because of the very nature of this disease: its insidious development, rarity, extremely chronic but cyclic course with spontaneous exacerbations and periods of inactivity, and the multiplicity of complications which sometimes overshadow the evidence of the primary disease. Treatment should not be postponed merely because neurological signs are absent and progressive skeletal changes are not appreciable. In acromegalics, such signs and symptoms as increased B.M.R., hyperglycemia, polydipsia, polyphagia with associated gain in wt. and excessive perspiration and night sweats, may be indicative of active "acromegalism." The authors conclude that acromegalics should be treated in 1 of 2 ways: by repeated series of roentgen ray therapy in dosage adequate to control at all times the endocrinological as well as the neurological symptoms, or by surgery. Consideration of a more radical attitude toward partial hypophysectomy is urged for endocrinological reasons alone, especially in young patients where the disease is not far advanced and in those who do not respond adequately to pituitary irradiation. Details of roentgen ray therapy and anthropometric measurements are appended for those who may be interested as well as a tabular chart designed to facilitate the follow-up on acromegalics.