Clinical Evidence regarding Functions of Pituitary 113 



conditions which are probably analogous to those of cachexia Jtypophyseo- 

 priva described by Paulesco, Gushing, and Biedl in the animals operated on 

 by them (pp. 100-102). It seems likely that this is the usual course of the 

 disease known as acromegaly. That the acromegalic skeletal growth is pro- 

 duced by hypertrophy and over-secretion of the anterior lobe is highly prob- 

 able, both as the result of partial extirpations in animals and from the effect 

 of operative removal of pituitary tumours in man. One case in particular 

 has been described (by Hochenegg) as having shown within a few days of 

 operation for removal remarkable amelioration of the symptoms, with 

 gradual diminution in size of the enlarged extremities, and eventually com- 

 plete cure. The thyroid gland both in this and in another instance which 

 was also successfully operated upon by the same surgeon became perman- 

 ently enlarged. In both, the pituitary tumour was a malignant adenoma. 

 In other cases operated on by Hochenegg, Gushing, and others, in some of 

 which an enlarged anterior lobe only was removed, the results have been 

 less striking than in the above example, but the retrogression of the disease 

 symptoms which resulted from the partial extirpation of the tumour has 

 occasionally been well marked. We are therefore warranted in believing 

 that the enlargement of the skeleton and the other signs which are 

 characteristic of acromegaly are due to hypertrophy of the anterior lobe 

 of the pituitary, whilst hypertrophy of the posterior lobe produces totally 

 different effects. 



The symptoms due to hypopituitarism vary according as the anterior 

 or the posterior lobe of the gland is mainly affected. In the former case 

 the chief effect seems to be upon the stature. When, however, it is the 

 posterior lobe which is affected, a tendency to fat formation and to deficient 

 sexual development are usually manifested, without being necessarily 

 accompanied by diminution in stature; indeed, these conditions may be 

 associated with increased growth of the body, although not especially affect- 

 ing the skeleton, a characteristic infantile condition being retained. Rarely 

 such symptoms of deficiency of posterior lobe occur along with acromegalic 

 symptoms, and are then associated with concomitant enlargement of anterior 

 lobe. That the adiposity is related to a deficiency of the posterior lobe is 

 further indicated by the fact that, according to Strada, it is never accom- 

 panied by glycosuria or polyuria, symptoms which are almost certainly the 

 result of increased activity of that lobe. 



In connexion with the influence of the anterior part of the organ on 

 growth, cases of dwarfs have been described in which the pituitary has 

 been noticeably small and atrophied; although it must be stated that 

 others have been recorded in which the contrary condition has been found. 

 The supposition that in these latter cases the enlargement is not a true 

 glandular growth as in acromegaly, but of an abnormal or destructive 

 character, is attractive. W T e must, however, be careful not to adopt it too 

 readily simply because it seems to fit in with what is believed to be the 

 effect of overgrowth of the organ in producing giants and acromegalics. 



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