Clinical Evidence regarding Functions of Pituitary 111 



and occasionally well-marked mammary development. Skiagrams of the 

 bones generally exhibit persistent epiphysial lines (fig. 80). The skin is 

 smooth and delicate and free from moisture. The nails are small and 

 thin, and the crescents at their base are absent. 



The tendency to adiposity is attributable by Gushing to deficiency of 

 posterior lobe secretion. This deficiency is usually associated with unusual 

 tolerance to sugar and an excessive assimilative power for carbohydrates, 

 which become transformed into fat and 

 thus produce adiposity. 



A subnormal body - temperature is 

 generally present with the above symp- 

 toms, as well as low arterial tension 

 and a slow pulse ; there is also often 

 drowsiness and torpidity. 1 Sometimes 

 evidences of psychic derangements and 

 occasionally a tendency to epilepsy have 

 been described. 



Hypopituitarism and its accompany- 

 ing symptoms may result from simple 

 atrophy of the gland, as appears to 

 have been the case in the instance of 

 infantilism shown in the accompanying 

 figure from Byrom Bramwell (fig. 79); 

 in this subject the skiagram showed a 

 small sella turcica. Or it may be caused 

 by destruction of the gland, e.g. by the 

 formation of a cyst, or as the result of 

 pressure from a neighbouring tumour. 



When the hypopituitarism comes on 

 after adolescence certain of the above 

 symptoms will be missed ; but the lowered 

 temperature, the tolerance to sugar, and the supervention of excessive 

 adiposity are generally present, as well as dryness of skin and loss of 

 hair, besides a tendency in the male to adopt the feminine type of trichosis, 

 even in cases where the male type has already been established. According 

 to Gushing, " pigmentation of the skin is a conspicuous feature of many of 

 the adult states, and as it is apt to be associated with asthenia or a low 

 blood-pressure it is natural to ascribe it to an associated adrenal insuffici- 

 ency, though it hardly reaches the degree of bronzing seen in some of the 

 Addisonian examples of adrenal tuberculosis." 



As has already been stated, the history of some cases of affections of 

 the pituitary shows symptoms characterising hypopituitarism following 

 those characteristic of hyperpituitarism, although of course little or no 



1 Gushing has pointed out that these symptoms closely resemble those which occur in 

 animals about to undergo hibernation. 



FIG. 79. Case of pituitary infantilism. 

 (Byrom Bramwell.) The patient was 

 27 when the photograph was taken. 

 His height was 4 feet 1| inches. 

 Notice the arrested development of 

 the sexual organs, the deficiency of 

 hair, the adiposity, the slender limbs 

 and digits, and the general approach 

 to the feminine type of body. 



