264 THE DISEASES OF THE HYPOPHYSIS 



there exist specific statements as to the examination of the urine. In 

 sixty- three cases, that is 35.5 per cent., diabetes was found; in eight cases 

 alimentary glycosuria. In many cases the diabetes shows the ordinary course 

 and eventually leads to death in coma. In many cases, however, as v. 

 Noorden first emphasized, the glycosuria shows a striking independence 

 from the sugar- value of the diet. The cases reported by me behaved thus: 



Observation XXIV. U, on diet rich in carbohydrates neg. 



XXV. T, alimentary glycosuria (100) pos. 



XXVI. Bo (distinct hyperthyrosis from thyroidin) neg. 



XXVII. Ta, alimentary glycosuria also on diet remarkably rich in 



carbohydrates strongly pos. 



XXVIII. Da, alimentary glycosuria pos. 



XXIX. Ad, alimentary glycosuria pos. 



XXX. St, alimentary glycosuria (also from levulose) pos. 



XXXI. Str, at first alimentary glycosuria pos. 



then later, on many investigations neg. 



Of eight cases, five were distinctly positive, and one for a time weakly 

 positive. In one case (Ta) we may even speak of a very light diabetes. 



The behavior toward adrenalin was tested in two cases (Observation St 

 and Observation Ta) with negative results. 



In many cases alimentary glycosuria or diabetes occurs only in the initial 

 stages of acromegaly; later these cases show a marked tolerance. W. 

 Schlesinger and Borchardt each report such a case. Lately also Gushing has 

 reported about such cases. In the case of Borchardt the diabetes had existed 

 five years; and later there occurred no glycosuria on the injection of 1 50 gm. of 

 grape-sugar. It should be mentioned that not rarely such diabetic disturb- 

 ances of metabolism occur in Basedow's disease (thyrogenic glycosuria). 



In the few cases in which I examined the excitability of the vegetative 

 nerves showed a very diverse behavior. In the case Ta there occurred, after 

 the injection of adrenalin, marked rise of blood-pressure, tachycardia and 

 arrhythmia. There also occurred marked diuresis, but not glycosuria. As 

 in this case sugar appeared in the urine after overloading with carbohydrates, 

 it stands as a fine example of the independence of the alimentary and the 

 nervous factors (Falta, Newburgh, and Nobel, Case 43). Also the in- 

 jection of pituitrinum infundibulare acted as a marked diuretic. After 

 the injection of pilocarpine there occurred only moderate sweats and a 

 moderate flow of saliva; although the patient stated that she suffered with 

 crises of copious sweats. In other cases the action of pilocarpine on the ex- 

 citability of the sweat glands was more distinct. Hence there may occur 

 temporary conditions of marked irritability of the sweat glands, without 

 hyperexcitability of them existing during the interval. The outbreaks of 

 sweat are known to be a very common symptom of acromegaly. Magnus- 

 Levy and Salomon in their cases of acromegaly regard the sweats as the symp- 



