294 



THE DISEASES OF THE HYPOPHYSIS 



We find that polyuria or polydipsia has been mentioned in the history 

 rather frequently. In v. Frankl-Hoctncart's statistics the picture of diabetes 

 insipidus occurred seven times. When I turn to the newer literature I find 

 that polyuria or at least transitory attacks of thirst are very frequent. I 

 cite the following case: 



Case i of Zack. Transitory polyuria, with urine of 1000 specific gravity. 

 Case Fucks.. At times attacks of thirst. 



Case Rosenhaupt. An average of 5^ liters of urine. Autopsy showed a 

 sarcoma of the anterior lobe of the pituitary. 



Case i of Bartels. Twenty-one-year-old man. 

 Polydipsia very pronounced. 



Case i of Cagnetto.- Nine-year-old girl, poly- 

 dipsia. 



Case Gotzl-Erdheim. Diabetes insipidus. 

 Own Observation (L, XXXIII) . Sometimes 

 intense feeling of thirst and polyuria. 



Own Observation (Si, XXXIV). Polydipsia 

 and polyuria, must get up several times at night. 

 Own Observation (Wi, XXXVI). At times 

 polyuria, with urine of low specific gravity. 



Own Observation (F, XLIV). Amounts of 

 urine up to 4000, specific gravity 1005-1010. 



Also a case of Frank's perhaps belongs here: 

 a thirty-nine-year-old corpulent man several years 

 ago attempted suicide by firing two bullets into 

 the right temple. Six to seven liters of urine 

 daily, of specific gravity 1005, Libido lost; X-ray 

 shows one of the bullets in the median line, pro- 

 jecting into the sella turcica from above. 



Hence there are found in a great number of 

 cases of hypophysial dystrophy, transitory or more 

 permanent polyuria, indeed in many cases 

 the condition may assume the picture of a severe 

 diabetes insipidus. 



The combination with polyuria occurs not 

 only in diseases of the hypophysis but also in dis- 

 eases that affect the neighborhood of the hypophysis (vicinity of the chiasma, 

 subthalmic region, etc.). As we shall consider these cases later in the dis- 

 cussion of the pathogenesis I shall bring to the front the most essential facts 

 in the existing clinical material. Oppenheim first pointed out that polyuria 

 frequently occurs in gummatous diseases of the chiasm. Of thirty-six 

 cases of basal luetic meningitis from the literature, twelve had polyuria. 

 Oppenheim himself reports two cases with autopsies. Spanbeck and Stein- 



FIG. 55. Tumor of the 

 subthalmic region with 

 diabetes insipidus. 



