Radiology · 1947 · 23 citations · 0 references
In 1931, J. Erdheim (4) first showed that the cartilage in acromegaly undergoes changes of both a proliferative and degenerative nature. The examples cited in his study are the cartilages of the ribs and vertebrae. The pathological process consisted of an increase in cartilaginous cells and intercellular substance, leading to a distention of the transitional zone between bone and cartilage. Proliferation was followed by degeneration with liquefaction and formation of vacuoles which were filled with deficient cartilaginous tissue. Later, ossification took place with or without previous calcification. According to Erdheim, this process of calcification and ossification may take place in the ribs and intervertebral disks in acromegaly. Another localization of these proliferative and degenerative changes in the cartilage of acromegalics was observed by H. v. Meyenburg (5), namely, the trachea and larynx. To his knowledge, his was the first such report. Experimental evidence of the action of anterior pituitary extract of cattle upon the articular cartilage of guinea-pigs was published by Silberberg in 1936 (6). He produced what he called an “acromegalic arthropathy.” Hypertrophy and hyperplasia started in the transitional zone of the cartilage, and areas of liquefaction subsequently developed. This was at times followed by calcification. When calcification did not occur, the areas of liquefaction broke down and ulcerated. To the above known localizations of calcification and ossification occurring in acromegaly, we wish to add a report of similar involvement of the auricles of the external ear in a long-standing case. Case Report B. R., a 63-year-old textile dealer, first exhibited symptoms of acromegaly thirty years ago, when he noticed that his hands were becoming gradually larger and his facial features distorted. He consulted Dr. Harvey Cushing, and a definite diagnosis of acromegaly was made. Surgery was suggested but refused. The patient subsequently received a course of radiation therapy to the pituitary gland at the Post Graduate Hospital in New York. He was then able to continue with his work for the following fifteen years, although symptoms became more pronounced. At the present time physical examination reveals a typical acromegalic facies, kyphosis, and spade-like hands and feet. General motor weakness is a prominent symptom; the skin is pale, and hair is absent from the chest, abdomen, and axilla. The voice is slow, indistinct, and high-pitched. The supra-orbital ridges are prominent; the eyebrows are almost absent and the palpebral fissures are narrow and slit-like. Examination of the eyes reveals bilateral cataracts. The lips are thick and bulging, and the mouth and tongue are enormously enlarged. The ears are likewise enlarged, displaced upward and backward, and are rigid. The chest is barrel-shaped, and there is a marked kyphosis. The angle of Ludwig measures about 90 degrees. The heart, lungs, and abdomen appear normal.