PATHOLOGICAL ANATOMY OF THE HYPOPHYSIS 269 



thirty- two-year-old woman without acromegaly; the hypophysis weighed 

 1.55 gm. which is thrice the normal weight; microscopically was found a 

 typical struma, in which small adenomatous portions alternated with 

 strumous portions. The analogous relation with the thyroid furnishes a 

 key in this case. There are also cases of Basedow's disease in which only 

 "Basedow's islands" are to be found in the thyroids. 



Pathogenesis. Already Pierre Marie had recognized the connection of 

 acromegaly with the hypophysis; at all events he supposed that the tumor 

 destroyed the functionating pituitary tissue, v. Strumpell, Arnold and others 

 advocated the opinion that enlargement of the hypophysis was coordinated 

 with that of the acral parts, in other words that it is only a partial phenome- 

 non of a general disturbance of metabolism (endogenous theory). The 

 theory of hyperfunction was first upheld by Tamburini, Benda, and Massa- 

 longo. Other authors have supposed a primary disturbance of function of 

 the sexual glands (Freund, Verstraeten, Stumme, lately E. Mayer, especially). 



Finally the endogenous theory has been modified by other authors 

 (Claude, Delllle) in that they regard acromegaly as a pluriglandular affection. 



The assumption of a loss of function of the hypophysis in acromegaly 

 can at the present day no longer be regarded as correct. We shall see later 

 that processes that destroy the glandular hypophysis never lead to- acro- 

 megalic symptoms, but to symptoms of an entirely different kind. The 

 same thing occurs in animals after the hypophysis has been extirpated. The 

 supposition of a primary functional disturbance of the sexual glands is no 

 longer tenable, in that, as we shall see later, there are cases of acromegaly in 

 which the sexual glands still functionate, even although the disease has been 

 fully developed for several years. Against the endogenous theory, speaks, 

 among other facts, the results of the partial extirpation of the tumor of the 

 hypophysis, as will be dealt with more in detail later. This places the 

 hypophysis as the central figure of the pathogenesis of acromegaly. That 

 in acromegaly other ductless glands are involved very frequently was already 

 mentioned by Pineles, which fact, as we have seen, makes the disease picture 

 very manifold. The circumstance that this involvement is a very diverse 

 one, that, for example, at one time there occurs on the part of the thyroid 

 symptoms of hyperfunction and at another time symptoms of those of 

 insufficiency shows once more the predominating position of the hypo- 

 physis. Hence only those manifestations may be regarded as cardinal 

 symptoms of acromegaly, which are to be referred directly to the altera- 

 tion of the hypophysis; there are in addition to these a herd of secondary 

 symptoms. 



Besides the results of the surgical treatment it is especially the similarity 

 of the pathologico-anatomical findings in the hypophysis in acromegaly 

 with those of the thyroid in Basedow's disease that indicate that acromegaly 

 is brought about through an increase in the function of the glandular hypophysis. 



