THE DISEASES OF THE HYPOPHYSIS 



The Metabolism. Very few investigations as to the metabolism of 

 hypophysial insufficiency have as yet been made. Already clinical observa- 

 tions would indicate that in hypophysial dystrophy there are considerable 

 alterations in metabolism. We not rarely find the statement that on the 

 one hand, at the beginning of the disease there occur a transitory polyphagia 

 and increased appetite. I refer to S, Observation XXXIV and Sch, Observa- 

 tion XXXVII, to be reported later. On the other hand, obesity that develops 

 gradually and which in certain cases may attain an excessive degree suggests 

 a reduction in the metabolism. 



Also the observation that after operation there is often an appreciable 

 reduction of body weight speaks to the same effect. Statements as to this 

 question are made by v. Frankl-Hochwart, concerning the first case that 

 v. Eiselsberg operated on with good results. Also in the case of Hirsch, 

 previously mentioned (Observation S, XXXIV), a reduction of 6 kg. in 

 weight followed during a short time after the operation. 



The investigations as to the fundamental exchange or the rest exchange 

 in dogs in which the hypophysis had been removed show unequivocally 

 an appreciable reduction of the respiratory gaseous "exchange (Benedict and 

 Romans, Forges and Aschner). 



The first experiments, in two cases of hypophysial dystrophy as reported 

 in the second edition of v. Noorden's book on "Obesity." These experiments 

 which were carried out by Forges gave rather normal values. The cases were 

 undoubted cases of hypophysial dystrophy and had been described by v. 

 Frankl-Hochwart. Later Bernstein found an appreciable reduction in one 

 case. Finally Bernstein and / have recently investigated a case. I here 

 tabulate the cases thus far investigated. 



The few cases do not furnish any certain conclusion. Only in Bern- 

 stein's case is the respiratory metabolism certainly reduced. This obser- 

 vation hence coincides with the experiences met with in animal experimenta- 

 tion. In case Fr, Observation XXXIV, values of comparison with values 

 furnished by a normal individual equally heavy and tall are lacking. 



The observation as to the carbohydrate metabolism in hypophysial dys- 

 trophy show a noteworthy opposite behavior to that in acromegaly. While 

 in acromegaly, in the great majority of cases, we find the tolerance for carbo- 

 hydrates more or less reduced, this has not as yet been found in hypophysial 

 dystrophy. On the contrary it seems, so far as investigations up to the 



