HYPOPHYSIAL DYSTROPHY 293 



trusion of the tumor into the third ventricle and giving off of the peduncle of the hypo- 

 physis from its lower surface. The tumor extends to the circle of Willis and hollows out 

 considerably both the temporal lobes; at the anterior pole of the tumor lie the flattened 

 optic nerves, which are wedged in between the tumor and the anterior cerebral arteries 

 and which show a squeezing together at this place; more on the left than on the right; the 

 lower pole of the tumor lies at the entrance to the sella turcica and dilates it. The dorsum 

 sellae is moderately eroded, the floor of the sella distinctly eroded, but moderately deep- 

 ened. In the sella is the hypophysis, which is of normal size with a slight concavity of its 

 upper surface. The tumor is a unilocular thin-walled cyst, in the clear yellowish contents 

 of which float consistent opaque flakes. General adiposity. 



A third case, which since this time has been investigated by Dr. Vias and 

 myself, is later set forth in detail. (Observation F, XLIV). It was that 

 of a juvenile dystrophy, the hypophysial origin of which is only conjectural. 



Therefore, in all three cases the endogenous uric-acid value is at the 

 lower limit of the normal, and the elimination of any purin that is adminis- 

 tered is protracted. Of course there exists the possibility that in such cases 

 the absorption of sodium nucleinate is incomplete. After all, even in this 

 respect, there is a noticeable difference from the state of affairs in the cases 

 of acromegaly investigated. 



Investigations as to the behavior of the vegetative nervous system in 

 hypophysial dystrophy are up to the present very scarce. As far as the ex- 

 citability of the vegetative nerves through pharmacological "means is con- 

 cerned, I can mention only the following: the glycosuric action of adrenalin 

 (i mg.) has failed in the cases I have thus far examined (Observations 

 XXXIII and XLIII, see later). 



After the injection of o.oi gm. of pilocarpine in case Si (XXXIV), there 

 was only a very slight sweat. After the injection of pituitrinum infundibu- 

 lare (2-3 cc. Parke, Davis 6* Co.'s preparation) there could be obtained a 

 marked diuretic action. Hence the excitability of the vegetative nerves 

 seems to be, as in myxedema, generally reduced. Perhaps the nervous 

 mechanism regulating temperature forms an exception to this (see part deal- 

 ing with the temperature). 



Many circumstances speak for the fact that there is a reduction in the 

 tonus of certain vegetative nerves. In all cases we find, for example, state- 

 ments as to the dryness of the skin and the lessened tendency to sweats. 



Here I might mention the statements of v. Frankl-Hochwart, and Frohlich, 

 that in hypophysial dystrophy there not infrequently occur vesical disturb- 

 ances. For the most part they have been referred to the compression of the 

 pes pedunculi by the growing hypophysial tumor; both authors express the 

 opinion that perhaps a reduction of the function of the posterior lobe and 

 lack of pituitrinum infundibulare is responsible. It would indeed be impor- 

 tant to pay attention to the behavior of the vesical disturbances in those 

 cases in which transitory polyuria points to an irritation of the posterior 

 lobe. I shall consider this symptom somewhat in detail. 



