HYPOPHYSIS CEREBRI 345 



infantile gigantism is supplied by the defective internal secretory 

 activity of the sexual glands. Fischera succeeded in modifying 

 the changes in the hypophysis after castration by the exhibition 

 of extract of the sexual glands, and this seems to suggest the 

 employment of the method in the treatment of secondary hypo- 

 physal disease. 



All researches into the pathogenesis of gigantism suggest 

 that the condition is the outcome of hyperpituitarism ; that, in the 

 acromegalic form, this hyperpituitarism is the primary cause of the 

 abnormal development of the body; while, in the infantile form, it 

 is probably the secondary result of primary disgenitalism, and 

 acts in concert with the latter. 



Another pathological condition associated \vith changes in the 

 hypophysis is hypophysal obesity, or dystrophia adiposogenitalis 

 (Bartels). This condition was first described by A. Frohlich 

 (1901). He found that, in a case which showed' symptoms of 

 hypophysal tumour, there was a very rapid increase in corpu- 

 lence, together with infantile character of the sexual glands, and 

 he assumed that this peculiar clinical complex was produced by a 

 specific action on the part of the hypophysis. Since that time 

 Frohlich 's type has been described by a large number of observers. 



The most striking symptom is the obesity, which may attain 

 enormous dimensions. It consists, partly in the deposition of fat 

 in certain localities particularly the breast and the abdomen and 

 partly in a general increase of the entire fat-body. At the same time 

 the skin is remarkably dry and low in temperature, the secretion 

 of the sweat glands is reduced, and there are trophic disturbances 

 of the hair and nails. The second important symptom is the 

 hypoplasia of the genitals, which is associated with imperfect 

 development of the secondary genital organs, together with 

 infantile habit. Symptoms of cerebral tumour, with suggested 

 localization in the hypophysis, complete the clinical picture. 



The etiological significance of the hypophysis in this con- 

 dition receives remarkable confirmation from a case described by 

 Madelung, that of a Q-year-old girl, who developed signs of 

 general obesity after a bullet wound in the head, the bullet remain- 

 ing lodged in the sella turcica. But Erdheim disputed the 

 hypophvsnl origin of this form of obesity, and showed that, in 

 isolated cases, the hypophysis is found under the microscope to 

 be entirely normal. He believes that the cause of the condition 

 lies in an influence exerted by a tumour in some area at the base 

 of the brain, and inclines to the infunclibulum, in which a trophic 

 centre may be assumed. According to Marburg, however, 

 Erdheim's observations do not supply proof of his theory; but 

 even if we allow it to stand and assume that the infundibulum only 

 is affected by the lesion, the condition might yet be due to indirect 

 disturbance of the hypophysis, owing to the destruction of the 

 glandular nerves which enter the hypophysis by way of the 

 infundibulum. 



