282 THE DISEASES OF THE HYPOPHYSIS 



(reported by Stumme and Exner) there occurred not only a disappearance of 

 the symptoms of cerebral pressure but also a retrogression of the acromegaly 

 manifestations as well. The teeth of the upper jaw again approached each 

 other, the acra became smaller, the skin softer and wrinkly, the menses re- 

 turned, and the abnormal hairiness again retrogressed; the retrogression of 

 the acromegalic skeletal alterations could also be demonstrated by the X-ray 

 (Hochenegg). In two cases, Exner saw an enlargement of the thyroid set in 

 after the operation. Since this time a number of other operated cases have 

 been reported, in part with good results (v. Eiselsberg, Kocher, Moskovitz, 

 Lecene, Gushing, O. Hirsch, and others). Especially striking was the result in 

 the case of 0. Hirsch, in which rheumatoid pains disappeared, the acra de- 

 creased in size, and the menses recurred and since that time remained regular. 

 Hochenegg, on the basis of a third case that pursued an unfavorable course, 

 points out that in cases in which the tumor is chiefly extrasellar the chances 

 of operation are always very much less. Considerable destruction of the 

 clinoid processes and slight deepening of the floor of the sella must, like 

 myodegeneratio cordis and status lymphaticus, be taken in consideration 

 when the question of operation arises. 



I refer again to the cases already described in detail that were operated 

 on by O. Hirsch. In one there came about an essential subjective and ob- 

 jective improvement. In the other case, which I saw again after a half 

 year, there had been no improvement at all. 



If in cases of acromegaly with high-grade brain-pressure affections a 

 radical operation is not possible, a palliative trepanation or an Anton's 

 "Balkenstich" [puncture of the corpus callosum] is to be thought of. 



The X-ray treatment of acromegaly was first suggested by Gramegna 

 and first practised by Beclere. It is stated that retrogression of the symptoms 

 of cerebral pressure and improvement in the visual disturbances have been 

 obtained (see also treatment of hypophysial dystrophia adiposo-genitalis) . 

 A result can be expected from thyroid-gland therapy only in cases complicated 

 with myxedema. Concerning the treatment of the more prominent symp- 

 toms of complicating Basedow's, I refer to the chapter on Basedow's dis- 

 ease. Otherwise in acromegaly the therapy can at most assuage pain by 

 means of antineuralgics and eventually combat cardiac insufficiency and the 

 decay of strength by means of general roborant measures. 



b. Hypophysial Dystrophy 



Hypopituitarismus, type Frohlich; dystrophia or degeneratio adiposo-genitalis. 



Historical. The occurrence of cerebral adiposity or of dysgenitalism 

 in tumors of the hypophysis was mentioned already by Babinski, Anderson, 

 Shuster, Uhthoff, and others. 



