270 THE DISEASES OF THE HYPOPHYSIS * 



Against this assumption there has been objected that in many cases as 

 above mentioned, there are found strumas of the glandular hypophysis in 

 which degenerative manifestations predominate, and that on the other hand 

 the strumas or small adenomata occur without acromegaly. ] believe that 

 the dictum of Kocher that there are strumas and strumas holds for the hypo- 

 physis as well as for the thyroid. To-day no one would be surprised that, 

 especially in the old Basedow's cases, parts of the thyroid are degenerated, 

 and that on the other hand small adenomata of the thyroid gland are often 

 unattended with any of the manifestations of Basedow's disease. The 

 morphological finding does not always indicate the functional condition. 

 Finally should be mentioned that in rare cases of acromegaly entirely normal 

 hypophyses are found. In many of these cases the diagnosis of acromegaly 

 is doubtful (syringomyela, congenital abnormal size of the acra, etc. 1 ). In 

 other cases we find dystopic adenomata of the hypophysis which proceed 

 from cut-off cells [versprengte Keime] (Erdheim and Haberfeld). 



I have already referred several times to the manifold analogies that exist 

 between the lesion of the thyroid gland and those of the hypophysis. As 

 we shall see later the assumption that hypophysial dystrophia adiposo- 

 genitalis depends on a lessened function of the hypophysis is based on ex- 

 perimental pathology in a fashion analogous to that in which the assumption 

 of myxedema is a hypothyrosis has been demonstrated by experiment. 

 On the contrary the conditions for acromegaly are to-day very much more 

 unfavorable than those for Basedow's disease. The most important support 

 for the theory that it depends on a hyperfunction of the hypophysis lies, as 

 I have mentioned previously, in the results of the surgical treatment of 

 acromegaly. Reduction in the size of the hypophysis through extirpation 

 of portion of the gland leads in many cases to a retrogression of the acromeg- 

 alic manifestations. That this is not true in all cases, for example, in the 

 case of U (Observation XXIV), does not seem to me of great significance, 

 as on account of the slight visibility of the field of operation, we do not know 

 anything as to the size and value of the piece of tumor left behind. In 

 analogy with experiences in Basedow's disease it is very probable that a 

 result could have been obtained by a further reduction of the tumor. 



On the contrary, the attempts to produce a hyperfunction of the hypo- 

 physis experiments have hitherto been attended with very slight results. 

 The stimulating [fordernd] influence of the hypophysis on the growth as 

 inferred from the clinical observations, has as yet not been demonstrated 



1 Also tall eunuchoids have been confused with acromegalics. Thus for instance we find 

 described by Gallais a case of "gigantisme acromegalique sans elargissement de la selle turcique" 

 with "inversion sexuelle and feminisme mental." In this case quite sudden rapid growth started 

 at fourteen and one-half years of age, that was also present to lesser degree in the twenty-fifth 

 year. Hands and feet were very long and slender. In the illustration that accompanies the 

 report of the case absolutely nothing of acromegaly is to be seen. It shows however typical 

 eunuchoid obesity. 



