Licence: Public Domain Mark
Credit: Acromegaly / Translated by F.R.B.Atkinson. Source: Wellcome Collection.
Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)
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![]No differential diagnosis can guard against an accidental complication {e.g., cancer of tlie stomacL in Dallemagne's third case), causing acromegaly to be overlooked until death. The diseases and conditions, in which the external shape of the body bears a resemblance to acromegaly, are numerous. Amongst them a number of very rare and imperfectly known affections are present. It is frequently easy to say that some one case of disease is not acromegaly, but very difficult or impossible to determine its true nature. We divide, for the purpose of consideration, the cases into three groups, according as to whether changes of the whole body, or chiefly the head or extremities, predominate. Myxoedema, firstly, shows changes of the whole body. The face is large, turgid, roundish, the skin every- where thickened. The hands and feet increased in circum- ference ; the tongue is also broader. The patients are sluggish and sleepy. More minute observation shows at once that the change is limited only to the soft parts, that the bones are not at all affected, that the skin feels tough and inelastic, the epidermis rough and scaly. The mental functions are not disturbed to such an extent in acromegaly as in myxoedema. Only if a tumour of the hypophysis occa- sions severe pressure symptoms is this the case ; but then also the other signs of cranial tumour stand out much more clearly than has ever been observed in the moderately enlarged hj^pophysis of myxoedema. Finally, in myxoedema metabolic processes are decidedly reduced, in acromegaly normal or increased. It must certainly not be forgotten that both diseases may be associated together (p. 89). Con- fusions v.dth myxoedema have been very frequent, as the history of acromegaly shows. The appearance of the adult cretin and cretinoid dwarf is so characteristic that confusion with any other disease is impossible. But it is otherwise in children. The puft'y lips and nose, the macroglossia, the cranium progcncum, the hypcrtrophied skin over the rcof of the skull and on the extremities, the short, thick, coarse, cylindrical bones, and the disturbance of the power of vision, may mako the distinction between cretinism and acromegaly difficult in a child. The disturbances of the intelligence and muscular energy are](https://iiif.wellcomecollection.org/image/b21273388_0111.jp2/full/800%2C/0/default.jpg)
