Clinical Evidence regarding Functions of Pituitary 109 



the pars intermedia rather than of the pars anterior. As the case advances 

 they may be replaced by high degrees of sugar tolerance, due to a sub- 

 sequent hypoplasia or degeneration of 

 pars intermedia. According to Andre 

 Levi, glycosuria occurs in 30 to 50 per 

 cent, of cases of acromegaly. It is in- 

 teresting to note that in pregnancy 

 also — in which the pituitary is found to 

 undergo enlargement — glycosuria not 

 infrequently occurs. 



Marie and Marinesco were originally 

 inclined to the opinion that acromegaly 

 is due to destructive disease of the 

 gland, since in many cases it is found 

 post-mortem that the tumour is of 

 malignant character and that the sub- 

 stance of the gland has been destroyed. 1 

 It was this idea which led to the carry- 

 ing out by various investigators of ex- 

 periments for the removal or destruction 

 of the organ in animals, in order to 

 produce, if possible, a similar syndrome. 

 But so far from producing increased 

 growth, this operation led to the opposite 

 result, the development of the skeleton 

 and body generally being retarded and 

 restrained. It is now recognised that 

 the tumours of the gland which are 

 associated with acromegaly are in the 

 first instance of a glandular (adeno- 

 matous) type ; although they may later 

 become of a malignant or of a cystic 

 nature and lead to the destruction of the 

 glandular tissue. It is therefore held 

 by most authorities that the char- 

 acteristic symptoms of acromegaly are 

 originally due to hyperpituitarism, i.e. 

 to increased function, although it may 

 be that there is also some degree of 

 perversion of function. In later stages effects of destruction may un- 

 doubtedly become apparent and supersede the symptoms of hypertrophy. 

 Sometimes the tumour of the gland is from the first malignant, but 



1 Marie appears more recently to have modified his views ; inclining on the whole to 

 the belief that it is a perversion and not a suppression of the secretion which leads to ihe 

 abnormal growth. 



Fig. 77. — Case of pituitary gigantism. 

 (Cushing. ) The patient was 3ti years of 

 age and 8 feet 3 inches high. Notice 

 the large elongated face, the dull heavy 

 expression, the long limbs, narrow chest, 

 enlarged joints, enormous hands and feet, 

 and the deficiency of hair (hypotrichosis). 

 The last is not a constant feature. 



