THE HYPOrilYSrS AND ACROMEGALY ()23 



urinary secretion, for extracts of the posterior lobe cause marked p(;ly- 

 uria, and in some instances of "diabetes insipidus," lesions have been 

 found in the hypophysis. Simmonds'-*^ holds that the pars intermedia 

 is responsible. Like the thyroid, the hypophysis enlarges during 

 pregnancy. ^^ Feeding of hypophysis is said to increase both gaseous 

 and nitrogenous metabolism, and in a case of hypopituitarism the 

 urine has been found to contain a high proportion of undetermined 

 nitrogen and of neutral sulphur.^" Varying results have been ob- 

 tained in studies on the basal metabolism of h\'poi)ituitarism.' 



Acromegaly. — The accumulating evidence seems to have practi- 

 cally proved that acromegaly depends upon a hyperfunctionating of 

 the anterior lobe tissue of the hypophysis, one of the most important 

 facts being the improvement which has followed removal of the hyper- 

 plastic tissues in several cases successfully operated. Although there 

 are many cases of tumor of the hypophysis without acromegaly, this 

 is of no significance since it is not to be expected that all tumors will 

 carry on the functions of the tissue in which they arise. Acromegaly 

 without hypophyseal changes is rare, especially if we consider the 

 finer cytological evidence of cellular activity.^ So far, little of chem- 

 ical interest has been learned concerning this disease. The metabo- 

 lism studies generally indicate a retention of nitrogen, phosphorus and 

 calcium, because of the overgrowth of bone and soft tissues.' Ac- 

 cording to some observers this retention is decreased, or changed to an 

 excess elimination, by administration of hypophyseal substance. ■• The 

 elimination of endogenous uric acid is said to be greatly increased 

 in acromegaly, and decreased in cases with hypofunction of the 

 gland. ^ A considerable excretion of creatine was observed by Ellis. ^ 



Glycosuria and actual diabetes is frequently present in acromegaly 

 (40 per cent, of the cases collected by Borchardt),^ presumably from 

 interference with the regulating function of the hypophysis, but this 

 assumption has been questioned because of the fact that lesions in 

 this location might also produce glycosuria by affecting the "diabetic 

 center." However, since puncture of the hypophysis causes glyco- 

 suria, while injection of posterior lobe extract produces glj'cosuria 

 dependent upon hyperglycemia (Gushing), and in view of the fact 

 brought out by Borchardt that in cases of tumor of the hypophysis 

 without acromegaly, glj'cosuria has never been observed, there is 



«" Munch, nied. "Woch., 1913 (60), 127. 



98 SeeErdheim and Stumme, Ziegler's Beitr., 1909 (46), 1. 



99 Stetten and Rosenbloom, Proc. Soc. exp. Biol, and Med., 1913 (10), 100. 



1 Means, Jour. Med. Res., 1915 (32), 121. 



2 See Lewis, Bull. Johns Hopkins' Hosp., 1905 (16), 157. 



3 See Bergeim, Stewart and Hawk. Jour. Exp. Med., 1914 (20), 218. 



^ See Rubinraut, Dissert., Zurich. Gebr. Leeman, 1912; Medigreceanu and 

 Kristeller, Jour. Biol. Chem., 1911 (9), 109. 



6 Falta and Nowaczvnski, Bed. klin. Woch., 1912 (49), 1781. 

 6 Jour. Amer. Med. Assoc, 1911 (56), 1870. 

 ' Zeit. klin. Med., 1908 (66), 332. 



