2Q2 THE DISEASES OF THE HYPOPHYSIS 



Alimentary glycosuria (200 gm.) negative. 



Diagnosis: Dystrophia adipose-genital is due to tumor in the region of the hypophysis. 



The investigation of elimination of uric acid on a purin-free diet gave the following 

 values: 



o.398-o.4o6-(2o gm. sodium nucleinate by mouth) 0.434-0.593. The endogenous 

 uric acid value hence lies rather low, at all events the elimination of uric acid after the 

 administration of purin is very low. 



The second case was the following: 



Observation XXXVI. G. Wi., twenty-eight years old [female]. Entered the clinic 

 May i, 1912. For one year headache without definite localization. Vertigo, vomiting, 

 ear noises at intervals of months, which for the last three months have occurred almost 

 weekly. Since childhood, slight weakness of vision on the left.. For the last six months, 

 decrease of vision on both sides, amaurosis on the left, still some vision remains on the 

 right, for the last months increase of weight. Absent menstruation for the last nine 

 months. Lues denied. 



Findings as concerning the lungs, heart, etc., normal; rather fat, especially on the 

 abdomen. Pupils unequal, left larger than the right. The left has lost its round contour, 

 does not react to light, the right reacts slowly. Accommodation on both sides good, globe 

 free, no nystagmus, corneal and conjunctival reflexes present. Fundus normal, right 

 temporal hemianopsia, basal limitation of the visual field, left amaurosis; facial nerve nor- 

 mal. Face hyperalgetic; trigeminus sensibility, temperature-sense, pain-sense, motility 

 and motor power normal. Patellar reflexes lively. Suspicious Babinski reflex on the left. 

 Abdominal reflexes present. No vertigo, no diplopia. 



X-ray: Sella turcica dilated quite lightly, especially in the infundibular part. This 

 finding does not speak unconditionally for hypophysial tumor, but may be present in other 

 brain tumors. 



Alimentary glycosuria: (100 gm. D) negative; (200 gm. D) trace. 

 The investigations of the uric-acid elimination on a purin-free diet show the following 

 values: 



o.287~o.334-(2o gm. sodium nucleinate by mouth) 0.513-0.206-0.298-0.214. 

 Hence the endogenous factor lies even lower than in the preceding case. Administra- 

 tion of purin increases the elimination of uric acid but very little. 



Quantities of urine up to 2400 cc. with specific gravities between 1005 and 1010. 

 Investigations as to the gaseous exchange (Bernstein) average of seven investigations. 

 COj elimination, 2.29 

 62 consumption 2.94 

 Blood-count: Erythrocytes, 4,600 ooo 

 Hemoglobin, 84 per cent. 

 Leucocytes, 7800 of which: 

 Polymorphonuclear leucocytes, 74.1 per cent. 

 Lymphocytes, 19.5 per cent. 

 Eosinophiles, 0.7 per cent. 

 Large mononuclears, 5.7 per cent. 



At the beginning of the stay at the clinic the patient was very sleepy, and uninterested. 

 Later there developed a clinical picture similar to Korsakof's psychosis, and the patient 

 was transferred to 11. Wagner's clinic. Increasing weakness, lately Babinksi reflex positive 

 on each side. Facial palsy on the left and pareses of the lower extremities. Pneumonia. 

 Death. 



August 6, 1912. Necropsy (assistant Erdheim) showed: Cystic hypophysial tumor 

 of the size of an apple, at the base of the brain, at the site of the infundibulum, with pro- 



