110 



The Endocrine Organs 



even then many of the cells tend to resemble those of the normal gland 

 (malignant adenoma) and symptoms of acromegaly may still be produced. 

 No one has yet succeeded in producing the effects of hyperpituitarism 

 experimentally, either by operation or by feeding with the gland. 



It must be stated that by no means every case of tumour of the pituitary 



is accompanied by the symptoms of acromegaly. For the disease may from 



the first be destructive and at once tend to the opposite condition, viz., 



. hypopituitarism. There is, as we have seen, evidence 



derived from the results of partial destruction in 



animals as to the symptoms which may result from 



such deficiency (p. 102). When similar symptoms 



occur in man, it is therefore natural to conclude that 



they have the same cause, viz., pituitary insufficiency; 



and in some cases it has been possible to obtain, by 



skiagrams or post-mortem examination, evidence of 



diminution in size of the organ. 



Hypopituitarism, produced either by diminution 

 in size or in activity of the gland, is probably the 

 cause of the syndrome described by Frbhlich (1901) 

 and termed by Bartels dystrophia adiposogenitalis. 

 The symptoms of this affection closely simulate those 

 of animals which have undergone partial or com- 

 plete removal of the gland. A case in which such 

 symptoms made their appearance was described by 

 Madelung in 1904, in a girl of nine years of age 

 (fig. 78) whose pituitary was destroyed by a bullet 

 which lodged in the sella turcica. 



The symptoms which are believed to be due to 

 pituitary insufficiency are, as might be supposed, the 

 reverse of those ascribed to hyperpituitarism. If the affection commence 

 before adolescence, the stature (instead of becoming gigantic as in hyper- 

 pituitarism) remains small (fig. 79). This is generally associated with 

 marked adiposity, so that the weight of the body may be large relatively 

 to the height. Sexual development is delayed and may remain consider- 

 ably in abeyance, producing a more or less permanent condition of sexual 

 infantilism. In the female the menses are irregular or absent, and in both 

 sexes there is deficient development of secondary sexual characters such 

 as the hair on the face (in the male) and over the pubes in both sexes. 

 Such hair as occurs in the last-mentioned situation in the male does not 

 extend to the umbilicus as is usual in that sex, but assumes the disposition 

 characteristic of the female, being limited to the mons veneris. On the 

 other hand, the hair of the head is generally abundant. Nor is the 

 character of the trichosis the only sign of feminism in subjects affected by 

 hypopituitarism. They usually have a broad pelvis, a certain amount of 

 genu valgum, rounded limbs, small feet and hands with tapering fingers, 



Fig. 78.— Case of bullet 

 wound of pituitary. 

 (Madelung.) 



