Aetiology and therapy (1890-1937)

The division between this chapter and the next is fairly arbitrary, but convenient as 1937 is the last year for which Atkinson FRB published his summary of papers relating to acromegaly which is a valuable secondary source of information for any researcher looking at acromegaly.

Gigantism and acromegaly same disease or different?

"The appearance of gigantism is never that of acromegaly. Gigantism is only an exaggeration of a normal process; acromegaly is a true disease." (Blair D 1899)

"Gigantism he considers to be the same disease as acromegaly, only occurring before adult life, that is during the period of growth." (Joffroy 1898)

Different forms of acromegaly

Harvey Cushing and acromegaly

The physiology and biochemistry of acromegaly

Aetiology

Proposed theories of acromegaly

Developments in biochemistry have clearly delineated the presence of growth hormone and it excess in acromegaly but previous to this a wide variety of possibilities were considered, Atkinson 1932.

• Nervous - e.g. lesion of the nervous system.
• Atavistic - return to neanderthal or anthropoid form.
• Thymus - functional disturbance of (several cases included enlargement of the thymus).
• Endogenetic - due to a primary change of metabolism, pituitary tumour one of the fundamental symptoms.
• Embryonic - noted persistence of craniopharyngeal canal in some acromegalic skulls.
• Glandular - especially hypophysis but other considered, thyroid and reproductive organs.
• The hypophysis
  1. Hyperpituitarism - Marie's original opinion.
  2. Dyspituitarism - modification in quality rather than quantity of the pituitary extract.
  3. Hyperpituitarism - due to tumour of the anterior lobe of the pituitary.

Atkinson in his analysis, 1932, also described three forms acromegaly can take from the many cases observed from their early beginnings through to the patients death (before positive treatment was available).

• Benign form - up to 50 years duration, can live into 70's e.g. Dr LP Mark, died aged 74.
• Chronic form - lasts from 8 - 30 years, this is the commonest type and includes the majority of cases.
• Acute malignant form - this lasts from 3 - 4 years, sarcoma of the hypophysis (one example of a secondary lesion).

Acromegaly and the "new photography" (Radiography)

"The photographs are interesting as showing that the increase in bulk of the extremities was due to an over growth of the soft tissues, and not to any alteration in the bones, thus indicating a highly practical use for the new photography."

It happens that the exact remedial treatment of a limb - not in acromegaly so much as other conditions; tuberculosis for instance - depends on a proper appreciation of the amount of structural change that has taken place in the bone; and the new photography should enable us to often arrive at that appreciation." (Broadbent WH 1896)

The surge of papers and cases (Medical oneupmanship?)

Veterinary