CHAPTEK XIV 

 THE PITUITARY BODY (continued) 



Clinical Evidence 



The clinical symptoms due respectively to overgrowth of the gland and 

 to deficiency of its secretion are very various. Although many of these 

 symptoms have long been described, some of them have only recently been 

 interpreted as the result of alterations in the pituitary, and certain affections 

 which were previously obscure are gradually becoming elucidated. This 

 advance in knowledge has mainly been due to the experiments on animals 

 of which a description has just been given. The literature of the subject 

 is rapidly becoming enormous. A large number of cases in which the 

 pituitary probably played a causative part have been described by Harvey 

 Cushing in The Pituitary Body and its Disorders, 1910, a work which 

 marks an epoch in the study of this organ from the clinical aspect. 



The course of many cases of disorder of the pituitary body (termed by 

 Cushing dyspituitarism) is as follows : Starting with enlargement of the 

 anterior lobe, they are heralded by symptoms of excessive function (hyper- 

 pituitarism). After a variable time — which may be greatly prolonged — 

 degenerative changes in the enlarged organ supervene, and there results 

 from this a gradual diminution (hypopituitarism), or even eventually an 

 entire loss of function (apituitarism). The primary enlargement is usually 

 first recognised by diminution of the visual field, caused by the pressure of 

 the enlarging gland upon the optic chiasma ; hence these affections generally 

 come first under the notice of the ophthalmic surgeon. Although there is 

 loss of vision, this may not be produced by actual destruction of nerve-fibres, 

 for it has frequently been noticed that after operation for removal of the 

 tumour or alleviation of the pressure produced by it the patient's vision is 

 speedily restored. Accompanying or preceding the visual symptoms certain 

 other signs are developed which point to the advent of a peculiar affection 

 (figs. 73, 74), termed acromegaly l by Marie (1886). The affection to which 

 this name was given by him had been already described by others, and 

 its association with enlargement of the pituitary body had been re- 

 cognised. It is, nevertheless, to Marie — associated later with Marinesco — 

 that we owe the first complete account of the syndrome in question. The 

 name which he bestowed upon it expresses its most prominent sign, 

 " hypertrophic singuliere non-congenitale des extremites superieures, in- 



1 &Kpov, point, extremity ; //.eyas, large. 

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