Subarachnoid hemorrhage secondary to a tumor of the hypophysis with acromegaly

CASES of acromegaly are infrequently encountered and when seen are looked upon as curiosities. The clinical syndrome of acromegaly was first described in 1886 by Pierre Marie, and the following year Minkowski * suggested that the disease was caused by derangement of the hypophysis cerebri. It is well known that acromegaly is associated with eosinophilic adenomas of the anterior lobe of the hypophysis. However, many cases of eosinophilic adenoma of the hypo-physis do not manifest acromegalic features nor other endocrine disturbances clinically. Although most writers 2 state that acromegaly occurs usually between the ages of 20 and 30 years, the author's cases have all been older, the youngest being 35 years and the oldest 74 years. The disease has not been observed to be hereditary; however, Levy3 noted in a series of cases that 30 per cent showed a familial tendency. The clinical picture usually is influenced by the size of the tumor and its intimate relationship to surrounding structures. The following case is being reported because of its unusual complication, a subarachnoid hemorrhage. CASE REPORT Clinical History. A 35 year old white male was admitted to the University Hospital on April 6, 1938, in a state of coma. Relatives stated that since the age of 14 the patient's hands and jaw had been large. In the past eight years there had been a marked increase in the size of the hands and jaw and his voice had become deeper. The patient had been married for 10 years and had no children. His wife stated that for the past three years his sexual power had been absent, although he had never been very aggressive sexually. The family history was negative for endocrine disturbances. * Received for publication November 16, 1945. This work was done prior to entry on active duty